Robert Luther Waddell, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

20345 Issued in OK

Practice address

435 N Monte Vista
Ada, OK 74820

Phone

(580) 310-0102

Fax

(580) 310-0104

NPI assigned

Sep 8, 2006

Last updated

Oct 27, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rwaddell429387@directc.mercy.net

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.

• Mercy Clinic Oklahoma Communities

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1386874550
  Medicare reassignment NPD
• Robert L Waddell MD PC

  • Surgery Physician
  • Ada, OK
  • NPI 1801030440
  Authorized official Same address or phone

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414368000000",
    "number": "1750485058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 N MONTE VISTA ST",
            "address_2": "SUITE A",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748204675",
            "telephone_number": "580-436-7101",
            "fax_number": "580-436-4447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 N MONTE VISTA",
            "city": "ADA",
            "state": "OK",
            "postal_code": "74820",
            "telephone_number": "580-310-0102",
            "fax_number": "580-310-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDELL",
        "first_name": "ROBERT",
        "middle_name": "LUTHER",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-08",
        "last_updated": "2014-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OK",
            "license": "20345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10015510A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luis H Vigil, M.D.
• Vincent M. Messbarger MD PLLC
• Nathan Vineyard
• Mercedes Volino, LPC
• Kalin Paul Vorwaller, DMD
• Jerry Wade
• Chance Wafford, PHARMD
• Marcus Shane Wahl, APRN
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0231)
• Anthony Wayne Waldroup, MD, MPH

• Surgery Physician in Ada, OK
• Providers in Ada, OK by specialty
• Surgery Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.