Organization Active NPI

Waller Family Health Systems LLC

  • Clinic/Center
  • Heath, TX
National Provider Identifier
1861720849
Registry record updated May 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
8656 Issued in TX
Legal business name
WALLER FAMILY HEALTH SYSTEMS LLC
Practice address
4210 Ridge Rd
Ste 102
Heath, TX 75032-6602
Phone
(972) 722-0054
Fax
(972) 722-0096
NPI assigned
Dec 2, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2023

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

Authorized official

Name
Dr. David Michael Waller, D.C.NPI 1023195781
Title
Owner, Doctor
Phone
(972) 722-0054

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 8656 TX Primary

Addresses

Primary practice location

4210 Ridge Rd
Ste 102
Heath, TX 75032-6602

Mailing address

4550 Sky Harbor Dr
Rockwall, TX 75087-0629
Phone (903) 629-5087

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100211000552 TX Part B Supplier - Clinic/Group Practice 3072656313 Receives reassigned benefits from 4 practitioners
Practice locations: Heath, TX

National Provider Directory

National Provider Directory

Locations

4210 Ridge Rd
Ste 102
Rockwall, TX 75032
Phone (903) 342-5261

2455 Ridge Rd
Ste 147
Rockwall, TX 75087
Phone (972) 722-0054

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1259712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683849600000",
    "number": "1861720849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 SKY HARBOR DR",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750870629",
            "telephone_number": "903-629-5087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4210 RIDGE RD",
            "address_2": "STE 102",
            "city": "HEATH",
            "state": "TX",
            "postal_code": "750326602",
            "telephone_number": "972-722-0054",
            "fax_number": "972-722-0096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLER FAMILY HEALTH SYSTEMS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-02",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER, DOCTOR",
        "authorized_official_telephone_number": "972-722-0054",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": "8656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Heath, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.