Individual provider Active NPI

Walter L. Schmalstieg Jr., M.D.

  • Child & Adolescent Psychiatry Physician
  • Ooltewah, TN
National Provider Identifier
1740209683
Registry record updated Nov 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
9600042 Issued in NC
Practice address
2615 Copper CV
Ooltewah, TN 37363-3002
Phone
(704) 609-6885
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 9600042 NC Primary

Addresses

Primary practice location

2615 Copper CV
Ooltewah, TN 37363-3002

Mailing address

2615 Copper CV
Ooltewah, TN 37363-3002
Phone (704) 609-6885

Other identifiers 2

IdentifierTypeStateIssuer
1740209683MedicaidNC
N0004DMedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, SC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230508000666 TX Practitioner - Psychiatry 7618016262 Reassigns benefits to 1 organization
I20230727000991 SC Practitioner - Psychiatry 7618016262 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9600042NCMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Low Country Health Care System, Inc CurrentSince Jul 5, 2023 Accepting new patients
Low Country Health Care System, Inc Current Accepting new patients
Low Country Health Care System, Inc. CurrentSince Jul 5, 2023 Accepting new patients
Spindletop MHMR Services CurrentSince Mar 24, 2023 Accepting new patients
Spindletop MHMR Services CurrentSince Mar 24, 2023 Accepting new patients
South Carolina Dept of Mental Health Accounting Office CurrentSince Feb 2, 2024 Accepting new patients
South Carolina Dept of Mental Health Accounting Office CurrentSince Feb 2, 2024 Accepting new patients
Resolutions Counseling and Mediation Services, PLLC Past Accepting new patients
Carolina Psychological and Psychiatric Health SRVS, PA PastSince Nov 1, 1999 Accepting new patients

Locations

86 Wren St
Barnwell, SC 29812
Phone (803) 259-5762

164 Waccamaw Medical Park Dr
Conway, SC 29526
Phone (843) 347-4888

333 Revolutionary Trl
Fairfax, SC 29827
Phone (803) 632-2533

2750 S 8th St
Beaumont, TX 77701
Phone (409) 838-6203

Organizations & group practices 9

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

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700006400000",
    "number": "1740209683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 COPPER CV",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373633002",
            "telephone_number": "704-609-6885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 COPPER CV",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373633002",
            "telephone_number": "704-609-6885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHMALSTIEG",
        "first_name": "WALTER",
        "middle_name": "L.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NC",
            "license": "9600042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740209683",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N0004D",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ooltewah, TN

Sources for this page

Verify at the official NPI Registry.