Charles Waller, MD is a medicare enrolled "General Practice" physician in Benton, Kentucky. His current practice location is
218 Bass Ln, Benton, Kentucky. You can reach out to his office (for appointments etc.) via phone at
(270) 556-3239.
Charles Waller is licensed to practice in Kentucky (license number 29738) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1306841341.
Physician's Profile
| Full Name | Charles Waller |
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| Gender | Male |
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| Speciality | General Practice |
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| Location | 218 Bass Ln, Benton, Kentucky |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1306841341
- Provider Enumeration Date: 06/16/2005
- Last Update Date: 02/01/2017
Medicare PECOS Information:
- PECOS PAC ID: 0244212645
- Enrollment ID: I20040601000835
Medical Identifiers
Medical identifiers for Charles Waller such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1306841341 | NPI | - | NPPES |
| 4047217 | Medicaid | TN | |
| 64297385 | Medicaid | KY | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208D00000X | General Practice | 29738 (Kentucky) | Primary |
| 207P00000X | Emergency Medicine | 29738 (Kentucky) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Charles Waller allows following entities to bill medicare on his behalf.
| Entity Name | Trigg County Hospital, Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1538218680
PECOS PAC ID: 5193620805
Enrollment ID: O20031205000118 |
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| Entity Name | Southeastern Emergency Physicians Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1356379382
PECOS PAC ID: 2466364997
Enrollment ID: O20050302000285 |
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| Entity Name | App Of Kentucky Ed, Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1497157341
PECOS PAC ID: 0749502862
Enrollment ID: O20141201000389 |
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| Entity Name | Hospital Medicine Services Of Tennessee Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1528433802
PECOS PAC ID: 9234432881
Enrollment ID: O20160803001623 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Charles Waller is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Charles Waller, MD
218 Bass Ln,
Benton, KY 42025-5824
Ph: (270) 556-3239 | Charles Waller, MD
218 Bass Ln,
Benton, KY 42025-5824
Ph: (270) 556-3239 |
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