Walter Russell Peters Jr, MD, MBA is a medicare enrolled "Colon & Rectal Surgery" physician in Dallas, Texas. His current practice location is
3409 Worth St, Worth Tower, Suite 640, Dallas, Texas. You can reach out to his office (for appointments etc.) via phone at
(469) 800-7180.
Walter Russell Peters Jr is licensed to practice in Texas (license number Q6358) 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 1316941123.
Physician's Profile
| Full Name | Walter Russell Peters Jr |
|---|
| Gender | Male |
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| Speciality | Colon & Rectal Surgery |
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| Location | 3409 Worth St, Dallas, Texas |
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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: 1316941123
- Provider Enumeration Date: 06/09/2005
- Last Update Date: 04/07/2022
Medicare PECOS Information:
- PECOS PAC ID: 2961421128
- Enrollment ID: I20151211000415
Medical Identifiers
Medical identifiers for Walter Russell Peters Jr such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1316941123 | NPI | - | NPPES |
| 1284609 | Other | MO | UNITED HEALTHCARE |
| 123497 | Other | MO | PHCS |
| 28058 | Other | MO | GHP |
| 5125 | Other | MO | HEALTHCARE USA |
| 8FM794 | Other | TX | BCBS |
| 25055 | Other | MO | ANTHEM BLUECROSS BLUESHIE |
| 3548646-01 | Medicaid | TX | |
| 4343317 | Other | MO | AETNA |
| 4343317 | Other | TX | AETNA |
| 431428562 | Other | MO | GREAT WEST |
| 1316941123 | Other | TX | NPI |
| 202523015 | Medicaid | MO | |
| A10787 | Other | MO | MERCY |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208600000X | Surgery | R6G45 (Missouri) | Secondary |
| 208C00000X | Colon & Rectal Surgery | R6G45 (Missouri) | Secondary |
| 208C00000X | Colon & Rectal Surgery | Q6358 (Texas) | Primary |
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. Walter Russell Peters Jr allows following entities to bill medicare on his behalf.
| Entity Name | Healthtexas Provider Network |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1760488936
PECOS PAC ID: 1355254210
Enrollment ID: O20040727001187 |
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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. Walter Russell Peters Jr 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 |
|---|
Walter Russell Peters Jr, MD, MBA
3409 Worth St, Worth Tower, Suite 640,
Dallas, TX 75246-2029
Ph: (469) 800-7180 | Walter Russell Peters Jr, MD, MBA
3409 Worth St, Worth Tower, Suite 640,
Dallas, TX 75246-2029
Ph: (469) 800-7180 |
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