Kensie Waller, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71006978A Issued in IN

Practice address

3834 S. Emerson Ave
BLDG C, Ste 100
Indianapolis, IN 46203

Phone

(317) 782-1577

Fax

(317) 780-5538

NPI assigned

Aug 31, 2016

Last updated

Aug 1, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Kensie Wagner Former name

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brookside Medical Home Visits LLCGroup PAC ID 8325389984, 8 clinicians

Ultra Health LLCGroup PAC ID 6800186602, 151 clinicians

Commonwealth Pain Associates PLLCGroup PAC ID 0941441919, 156 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Deaconess Hospital Inc Hospital, Evansville, IN, CCN 150082

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14578/brand/1/csg/1/fhir/r4
• Direct secure messaging: kensie.waller.1@28056.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brookside Medical Home Visits LLC

  • Family Nurse Practitioner
  • Clay City, IN
  • NPI 1306339742
  Medicare reassignment Care Compare group NPD
• Commonwealth Pain Associates, PLLC

  dba Commonwealth Pain and Spine

  • Interventional Pain Medicine Physician
  • Louisville, KY
  • NPI 1306280177

  Family, IN

  Medicare reassignment Care Compare group NPD
• Ultra Health LLC

  dba Ultra Health Provders

  • Geriatric Medicine (Internal Medicine) Physician
  • Nashville, TN
  • NPI 1922469543

  IN

  Medicare reassignment Care Compare group NPD
• Advanced Healthcare Associates LLP

  • Geriatric Medicine (Internal Medicine) Physician
  • Elwood, IN
  • NPI 1841225091

  Family

  Medicare reassignment NPD
• Altea Medical Indiana PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Gary, IN
  • NPI 1992584783
  Medicare reassignment NPD
• Directed Rehabilitation Services

  • Physical Medicine & Rehabilitation Physician
  • Noblesville, IN
  • NPI 1063037398
  Medicare reassignment NPD
• Sound Physicians of Indiana, LLC

  • Hospitalist Physician
  • Gary, IN
  • NPI 1528311149
  Medicare reassignment NPD
• Post Acute Medical PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Lanham, MD
  • NPI 1730713025

  IN

  Medicare reassignment NPD
• Brookside Medical Home Visits LLC

  • Durable Medical Equipment & Medical Supplies
  • Carmel, IN
  • NPI 1770340051
  NPD
• Sound Physicians of Indiana, LLC

  dba Sound Physicinas of Indiana

  • Hospitalist Physician
  • Terre Haute, IN
  • NPI 1184063257
  NPD
• Sound Physicians of Indiana, LLC

  • Hospitalist Physician
  • Mishawaka, IN
  • NPI 1356687164
  NPD
• Commonwealth Pain Associates PLLC

  dba Commonwealth Pain And Spine

  • Durable Medical Equipment & Medical Supplies
  • Paducah, KY
  • NPI 1114753720
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Deaconess Hospital Inc

  dba The Women's Hospital

  • General Acute Care Hospital
  • Newburgh, IN
  • NPI 1780535427
  Care Compare affiliation
• Deaconess Hospital, Inc.

  • General Acute Care Hospital
  • Evansville, IN
  • NPI 1053361642
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533081600000",
    "number": "1730635681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3299",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897023299",
            "telephone_number": "317-782-1577",
            "fax_number": "317-780-5538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3834 S. EMERSON AVE",
            "address_2": "BLDG C, STE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46203",
            "telephone_number": "317-782-1577",
            "fax_number": "317-780-5538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "KENSIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-31",
        "last_updated": "2018-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71006978A",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28216896A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "PENDING",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENSIE",
            "last_name": "WAGNER",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mark Wallen, RBT
• William Wallen, MD
• Bruce F Waller, MD
• Fay Marshelle Waller, FNP-BC
• Keiona L Waller, APRN, FNP-BC
• Laura M Waller
• Barbara J Walling, FNP
• Guy R Walling, NP NURSE PRACTITIONE
• Martina Lynn Walling, PHARMD
• Radhika V Walling, M.D.

• Family Nurse Practitioner in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.