Stanley J Waters, M.D., PH.D.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

M6247 Issued in ID

Practice address

1673 Shoreline Dr
Ste 100
Boise, ID 83702-6736

Phone

(208) 322-0485

Fax

(208) 378-8228

NPI assigned

May 5, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ID

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, Doctor of Philosophy

State licenses

Practice roles

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.

• Stanley J Waters

  • General Acute Care Hospital
  • Emmett, ID
  • NPI 1023367828
  NPD (past)

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430784000000",
    "number": "1821046335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1673 SHORELINE DR",
            "address_2": "STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026736",
            "telephone_number": "208-322-0485",
            "fax_number": "208-378-8228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1673 SHORELINE DR",
            "address_2": "STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026736",
            "telephone_number": "208-322-0485",
            "fax_number": "208-378-8228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "STANLEY",
        "middle_name": "J",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2015-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "ID",
            "license": "M6247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000039400",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER #",
            "identifier": "71928",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER #",
            "identifier": "000010004618",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Waste, LMSW
• David Allen Waterman, MD
• Janessa Waterman, NP-C
• Bradley Kent Waters, D.C., D.I.C.C.P.
• C. Dustin Waters, PHARMD
• Cassi Mendiola Watkins, R.D., L.D.
• Erica Watkins, OTR
• Miesha Dawn Watkins, LMT, NMT
• Ryan Armanni Watkins
• Troy B Watkins Jr., M.D.

• Orthopaedic Surgery Physician in Boise, ID
• Providers in Boise, ID by specialty
• Orthopaedic Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2015; 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.