Individual provider Active NPI

Brian J Walters, MD

  • Family Medicine Physician
  • Union, KY
National Provider Identifier
1750511929
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
43598 Issued in KY
Practice address
1808 Bristow Drive
Primary Care-Union Bristow Drive
Union, KY 41091-3513
Phone
(859) 301-7210
Fax
(859) 301-7216
NPI assigned
Jul 21, 2009
Last updated
Mar 30, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R1880 KY
Family Medicine Physician 207Q00000X 43598 KY Primary

Addresses

Primary practice location

1808 Bristow Drive
Primary Care-Union Bristow Drive
Union, KY 41091-3513

Mailing address

PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 301-7210

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20110801000295 KY Practitioner - Family Practice 9133398522 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kentucky College of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Medical Group IncGroup PAC ID 2163326240, 803 clinicians

Practice addresses (Care Compare)

8726 US
Suite 42
Florence, KY 41042-9625
Phone (859) 384-2660

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43598KYMDFamily Medicine Physician
R1880KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, Inc. CurrentSince Aug 15, 2011 Accepting new patients
Summit Medical Group, Inc Family Medicine CurrentSince Aug 15, 2011 Accepting new patients

Locations

334 Thomas More Pkwy
Crestview Hills, KY 41017
Phone (859) 331-6065

1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700

238 Barnes Rd
Williamstown, KY 41097
Phone (859) 292-4000

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

Interoperability endpoints

  • Direct secure messaging: bwalters110382@direct-prd.stelizabeth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1248134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1750511929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635283",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635283",
            "telephone_number": "859-301-7210",
            "fax_number": "859-301-7216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 BRISTOW DRIVE",
            "address_2": "PRIMARY CARE-UNION BRISTOW DRIVE",
            "city": "UNION",
            "state": "KY",
            "postal_code": "410913513",
            "telephone_number": "859-301-7210",
            "fax_number": "859-301-7216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "BRIAN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-21",
        "last_updated": "2021-03-30",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "R1880",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "43598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Union, KY

Sources for this page

Verify at the official NPI Registry.