NPIMap

Individual provider Active NPI

Eddie Clark Waldheim Jr., M.D.

  • Family Medicine Physician
  • Maitland, FL
National Provider Identifier
1881797082
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME46344 Issued in FL
Practice address
402 Lake Howell Rd
Maitland, FL 32751-5907
Phone
(407) 628-4312
Fax
(407) 628-1845
NPI assigned
Sep 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME46344 FL Primary

Addresses

Primary practice location

402 Lake Howell Rd
Maitland, FL 32751-5907

Mailing address

402 Lake Howell Rd
Maitland, FL 32751-5907
Phone (407) 628-4312

Other identifiers 1

IdentifierTypeStateIssuer
370808000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20100921001127 FL Practitioner - Family Practice 3476678962 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of South Florida College of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ability Health Services, IncGroup PAC ID 4082523329, 1,249 clinicians
Ability Health Services and Rehabilitation LPGroup PAC ID 4981986288, shared by 2 NPIs, 1,260 clinicians
Adventhealth Primary Care Network IncGroup PAC ID 1557722410, 428 clinicians

Practice addresses (Care Compare)

1200 Lexington Green LN
Sanford, FL 32771-1013

402 Lake Howell Rd
Maitland, FL 32751-5907
Phone (407) 628-4312

661 E Altamonte Dr
Suite 115
Altamonte Springs, FL 32701-5102
Phone (407) 831-4040

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

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

State licenses

LicenseStateTypeSpecialty
ME46344FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Family Medicine CurrentSince Dec 20, 2021 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Dec 20, 2021 Accepting new patients
Adventhealth Primary Care Network Inc Family Medicine CurrentSince Nov 1, 2023 Accepting new patients

Locations

661 E Altamonte Dr
Ste 115
Altamonte Springs, FL 32701
Phone (407) 831-4040

402 Lake Howell Rd
Maitland, FL 32751
Phone (407) 628-4312

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

Interoperability endpoints

  • Direct secure messaging: ewaldheim131305@adventhealth.direct-ci.com
  • Direct secure messaging: eddiewaldheim@mfpfl.allscriptsdirect.net

Organizations & group practices 3

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.

Hospital & facility affiliations 12

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": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208822400000",
    "number": "1881797082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 LAKE HOWELL RD",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515907",
            "telephone_number": "407-628-4312",
            "fax_number": "407-628-1845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 LAKE HOWELL RD",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515907",
            "telephone_number": "407-628-4312",
            "fax_number": "407-628-1845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDHEIM",
        "first_name": "EDDIE",
        "middle_name": "CLARK",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2008-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME46344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370808000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

Verify at the official NPI Registry.