NPIMap

Individual provider Active NPI

Zachary Connell Watters

  • Internal Medicine Physician
  • Cleveland, MS
National Provider Identifier
1871243261
Registry record updated Jun 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35097 Issued in MS
Practice address
810 E Sunflower Rd
Cleveland, MS 38732-2800
Phone
(662) 843-3606
Fax
(662) 846-1194
NPI assigned
Mar 28, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35097 MS Primary

Addresses

Primary practice location

810 E Sunflower Rd
Cleveland, MS 38732-2800

Mailing address

810 E Sunflower Rd
Cleveland, MS 38732-2800
Phone (662) 843-3606

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250702002202 MS Practitioner - Internal Medicine 4284159336 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Mississippi School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bolivar Physician Practices LLCGroup PAC ID 6305995895, 17 clinicians

Practice addresses (Care Compare)

810 E Sunflower Rd
Suite 100 a
Cleveland, MS 38732-2828
Phone (662) 843-3606

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bolivar Physician Practices LLC CurrentSince Aug 1, 2025 Accepting new patients
Bolivar Physician Practices LLC CurrentSince Aug 1, 2025 Accepting new patients
PHC-Cleveland LLC Past Accepting new patients
Bolivar Physician Practices LLC Internal Medicine Past Accepting new patients

Locations

810 E Sunflower Rd
Cleveland, MS 38732
Phone (662) 579-3484

907 E Sunflower Rd
Ste 102
Cleveland, MS 38732
Phone (662) 545-4443

810 E Sunflower Rd
Ste 100A
Cleveland, MS 38732
Phone (662) 579-0118

Interoperability endpoints

  • Direct secure messaging: zachary.watters.1@20428.direct.athenahealth.com
  • Direct secure messaging: zachary.watters.1@10381.direct.athenahealth.com

Organizations & group practices 4

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 7

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": "1648425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750291200000",
    "number": "1871243261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 E SUNFLOWER RD",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322800",
            "telephone_number": "662-843-3606",
            "fax_number": "662-846-1194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 E SUNFLOWER RD",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322800",
            "telephone_number": "662-843-3606",
            "fax_number": "662-846-1194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTERS",
        "first_name": "ZACHARY",
        "middle_name": "CONNELL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-28",
        "last_updated": "2025-06-19",
        "certification_date": "2025-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "35097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, MS

Sources for this page

Verify at the official NPI Registry.