Giacomo Colver Waller, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

322610 Issued in NY

Practice address

19 E 98TH St, 7TH FL
Ste a, Box #1259
Ny, NY 10029-6574

Phone

(212) 241-0949

Fax

(212) 534-2654

NPI assigned

Mar 26, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

General Surgery

Education

Emory University School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Icahn School of Medicine at Mount SinaiGroup PAC ID 8224282926, 317 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Elmhurst Hospital Center Hospital, Elmhurst, NY, CCN 330128

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678

Interoperability endpoints

• Direct secure messaging: gwaller5234916@nychhc.direct-ci.com

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.

• Icahn School of Medicine at Mount Sinai

  • Orthopaedic Surgery Physician
  • Elmhurst, NY
  • NPI 1609120674
  Medicare reassignment Care Compare group NPD
• Icahn School of Medicine at Mount Sinai

  • Surgery Physician
  • Elmhurst, NY
  • NPI 1073867040
  NPD
• Icahn School of Medicine at Mount Sinai

  • Diagnostic Radiology Physician
  • Elmhurst, NY
  • NPI 1619221686
  NPD
• New York City Health and Hospitals Corporation

  • General Acute Care Hospital
  • Elmhurst, NY
  • NPI 1063426377
  NPD (past)
• New York City Health and Hospitals Corporation

  • General Acute Care Hospital
  • Bronx, NY
  • NPI 1679587679
  NPD (past)

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

• New York City Health and Hospitals Corporation

  • General Acute Care Hospital
  • Elmhurst, NY
  • NPI 1063426377
  Care Compare affiliation

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690070400000",
    "number": "1801391438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 E 98TH ST, 7TH FL",
            "address_2": "STE A, BOX #1259",
            "city": "NY",
            "state": "NY",
            "postal_code": "100296574",
            "telephone_number": "212-241-0949",
            "fax_number": "212-534-2654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 E 98TH ST, 7TH FL",
            "address_2": "STE A, BOX #1259",
            "city": "NY",
            "state": "NY",
            "postal_code": "100296574",
            "telephone_number": "212-241-0949",
            "fax_number": "212-534-2654"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1364 Clifton Rd NE Ste H100",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303221059",
            "country_code": "US",
            "telephone_number": "404-727-0093",
            "fax_number": "404-712-0561",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2160 S 1st Ave Ste 2840",
            "address_purpose": "LOCATION",
            "city": "Maywood",
            "state": "IL",
            "postal_code": "601533328",
            "country_code": "US",
            "telephone_number": "708-216-4533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "GIACOMO",
        "middle_name": "COLVER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-26",
        "last_updated": "2023-07-23",
        "certification_date": "2023-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "125.077143",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125.077143",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "322610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOISE DFPR",
            "identifier": "125.077143",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE EDUCATION DEPARTMENT OFFICE OF THE PROFESSIONS",
            "identifier": "322610",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abby Ventura, MD, MBA
• Eamonn Vitt, MD
• Russell George Volpe, DPM
• Sandra Walford-Lallemand, PT
• Mary Ann G. Walker, NP
• Romina G. Wancier, MD
• Danalee Wechsler
• Chana Linda Weller, DDS, M.S.
• Justin Wernick, DPM
• Maria Fernanda Wilber, LCSW

• Surgery Physician in Ny, NY
• Providers in Ny, NY by specialty
• Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2023; 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.