Richard Edmund Waller, M.D.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

0101040746 Issued in VA

Practice address

14355 Sommerville CT
Midlothian, VA 23113

Phone

(804) 379-7721

Fax

(804) 379-7699

NPI assigned

May 4, 2006

Last updated

Mar 24, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• CJW Infectious Disease LLC

  • Infectious Disease Physician
  • Richmond, VA
  • NPI 1578501060
  NPD (past)
• Old Dominion Physical Medicine PLLC

  • Physical Medicine & Rehabilitation Physician
  • Richmond, VA
  • NPI 1508250697
  NPD (past)

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300924800000",
    "number": "1871541862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14355 SOMMERVILLE CT",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "23113",
            "telephone_number": "804-379-7721",
            "fax_number": "804-379-7699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14355 SOMMERVILLE CT",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "23113",
            "telephone_number": "804-379-7721",
            "fax_number": "804-379-7699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "RICHARD",
        "middle_name": "EDMUND",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2011-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "VA",
            "license": "0101040746",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "VA",
            "license": "0101040746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010131855",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Anne Wallace, MD
• James C Wallace, DDS
• Laurel Slough Wallace, D.O.
• Rochelle Wallace
• Jennifer B. Walle, PT, DPT
• Timothy Michael Walsh
• Danesha Walters
• Stephanie Walton
• Tiffany Walton
• Maria Ward

• Neurology Physician in Midlothian, VA
• Providers in Midlothian, VA by specialty
• Neurology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2011; 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.