Gregory Waltz, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4704314350 Issued in MI

Practice address

29500 Southfield Rd
Southfield, MI 48076-2030

Phone

(248) 765-1795

NPI assigned

Oct 9, 2021

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

Medicare fee-for-service enrollment

Enrolled in MI, OH2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mustard Seed Family Counseling LLCGroup PAC ID 3870913361, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Mustard Seed Family Counseling LLC

  • Professional Counselor
  • Sterling Heights, MI
  • NPI 1366905408

  OH

  Medicare reassignment Care Compare group NPD
• Emotional Advantage LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ferndale, MI
  • NPI 1447647789
  NPD (past)

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

{
    "created_epoch": "1633737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633737600000",
    "number": "1811659592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4936 WOOD ST",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483293479",
            "telephone_number": "541-554-7808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29500 SOUTHFIELD RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762030",
            "telephone_number": "248-765-1795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTZ",
        "first_name": "GREGORY",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-09",
        "last_updated": "2021-10-09",
        "certification_date": "2021-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704314350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terrie Walton-Banks
• Candace Walton
• Makenzie Walton
• Naudia Walton
• Nicholas Walton
• Shalini Walvekar
• Sheel Walvekar
• Wanda Edwards
• Kenneth Mark Wardowski, PA
• Dominique Ware, LMSW

• Psychiatric/Mental Health Nurse Practitioner in Southfield, MI
• Providers in Southfield, MI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2021; 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.