Zachry Lane Waterson, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0200245A Issued in IN

Practice address

750 Broadway
Suite 350
Fort Wayne, IN 46802-1411

Phone

(260) 423-2682

Fax

(260) 422-4326

NPI assigned

Jun 21, 2006

Last updated

Jun 3, 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 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IN

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

Merit-based Incentive Payment System (MIPS)

Final score

97.04 of 100Reported as group

Quality

79.76

Promoting interoperability

94

Improvement activities

40

Cost

85.08

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: zachry.waterson.1@17223.direct.athenahealth.com
• Direct secure messaging: zachry.waterson@nhci.eclinicaldirectplus.com

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.

• Neighborhood Health Clinics, Inc

  • Clinic/Center
  • Fort Wayne, IN
  • NPI 1548291222

  Family Medicine

  Medicare reassignment NPD
• Fort Wayne Medical Education Program

  dba The Family Medicine Center

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1184635153
  Medicare reassignment
• Neighborhood Health Clinics, Inc

  • Clinic/Center
  • Fort Wayne, IN
  • NPI 1730989518
  NPD
• Associated Family Medical Consultants PC

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1265454755
  NPD (past)
• Emergency Medicine of Indiana

  • Emergency Medicine Physician
  • Fort Wayne, IN
  • NPI 1952356883
  NPD (past)
• Professional Emergency Physicians PC

  • Emergency Medicine Physician
  • Fort Wayne, IN
  • NPI 1144215096
  NPD (past)

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307059200000",
    "number": "1902842677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 BROADWAY",
            "address_2": "SUITE 150",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468021411",
            "telephone_number": "260-423-2682",
            "fax_number": "260-422-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 BROADWAY",
            "address_2": "SUITE 350",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468021411",
            "telephone_number": "260-423-2682",
            "fax_number": "260-422-4326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERSON",
        "first_name": "ZACHRY",
        "middle_name": "LANE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2011-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "0200245A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000000222712",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MPLAN",
            "identifier": "000000015336",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200231240",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacy Waterman, PHARMD
• Angela Waters, LMHCA
• Jayda Waters, RBT
• Megan Elizabeth Waters
• Storey A Waters
• Iris Teresa Watkins, LSW
• Marianne Watkins, MD
• Marilyn F Watkins, CFNP
• Roxana M Watkins, PTA
• Althea Watson

• Family Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.