Active NPI
Kim W. Waterfall, M.D.
- Family Medicine Physician
- Columbus, OH
National Provider Identifier
1992782098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 090079
- Practice address
- 5571 Chowning Way
Columbus, OH 43213-1479 - Phone
- (614) 625-6621
- NPI assigned
- Dec 29, 2005
- Last updated
- Apr 13, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 090079 | OH | Primary |
Addresses
Primary practice location
5571 Chowning Way
Columbus, OH 43213-1479
Mailing address
5571 Chowning Way
Columbus, OH 43213-1479
Phone (614) 625-6621
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000111941 | Other | IN | ANTHEM |
| 00000499190 04 | Other | UNITED HEALTHCARE | |
| 200115550 | Medicaid | IN | |
| 7336 | Other | IN | PHYSICIANS HAELTH PLAN |
| 3937240020 | Other | IN | MEDICARE DMEPOS |
| 5736320 | Other | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 090079 | OH | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239580800000",
"number": "1992782098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5571 CHOWNING WAY",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432131479",
"telephone_number": "614-625-6621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5571 CHOWNING WAY",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432131479",
"telephone_number": "614-625-6621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERFALL",
"first_name": "KIM",
"middle_name": "W.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-29",
"last_updated": "2009-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "090079",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000111941",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "00000499190 04",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200115550",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIANS HAELTH PLAN",
"identifier": "7336",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE DMEPOS",
"identifier": "3937240020",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5736320",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.