CHARLES WALLER MD NPI 1306841341

NPI Information

  • NPI: 1306841341
  • Provider Name: CHARLES WALLER, MD
  • Classification: General Practice - 208D00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 218 BASS LN
    BENTON, KY
    ZIP 42025
  • Phone: (270) 556-3239

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NPI Details

Charles Waller, MD is a general practice in Benton, KY with 34 years of experience. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee Charles Waller, MD NPI is 1306841341. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE
Graduation Year:1992

The provider's business location address is:

218 BASS LN
BENTON, KY
ZIP 42025-824
Phone: (270) 556-3239
Fax: (270) 354-5865

The NPI 1306841341 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Emergency department visit for life threatening or functioning severity (HCPCS:99285)
  • Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only (HCPCS:93010)
  • Emergency department visit for problem of high severity (HCPCS:99284)
  • Emergency department visit for problem of moderate severity (HCPCS:99283)

The enumeration date for this NPI number is 6/16/2005 and was last updated on 2/1/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207P00000XEmergency Medicine29738KENTUCKYNo
2208D00000XGeneral Practice29738KENTUCKYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10933213MEDICARE PINKENTUCKY
24047217MEDICAIDTENNESSEE
30924401MEDICARE ID-TYPE UNSPECIFIEDKENTUCKY
464297385MEDICAIDKENTUCKY
5F72255MEDICARE UPINKENTUCKY
60935608MEDICARE PINKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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