Mrs Holli Dezaun Waller, DO - Medicare Family Practice in Blacksburg, VA

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Mrs Holli Dezaun Waller, DO is a medicare enrolled "Family Medicine" physician in Blacksburg, Virginia. She went to Lake Erie College Of Osteopathic Medicine, Erie and graduated in 2010 and has 14 years of diverse experience with area of expertise as Family Practice. She is a member of the group practice Premier Provider Health Pa and her current practice location is 3700 South Main Street, Blacksburg, Virginia. You can reach out to her office (for appointments etc.) via phone at (540) 953-5445.

Mrs Holli Dezaun Waller is licensed to practice in Virginia (license number 0116022785) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1053622167.

Contact Information

Mrs Holli Dezaun Waller, DO
3700 South Main Street,
Blacksburg, VA 24060
(540) 953-5445
(540) 953-5453

Map and Direction




Physician's Profile

Full NameMrs Holli Dezaun Waller
GenderFemale
SpecialityFamily Practice
Experience14 Years
Location3700 South Main Street, Blacksburg, Virginia
Accepts Medicare AssignmentsYes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Mrs Holli Dezaun Waller attended and graduated from Lake Erie College Of Osteopathic Medicine, Erie in 2010
  NPI Data:
  • NPI Number: 1053622167
  • Provider Enumeration Date: 06/24/2010
  • Last Update Date: 06/24/2010
  Medicare PECOS Information:
  • PECOS PAC ID: 6800043977
  • Enrollment ID: I20140327000229

Medical Identifiers

Medical identifiers for Mrs Holli Dezaun Waller such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1053622167NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207Q00000XFamily Medicine 0116022785 (Virginia)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Hca Houston Healthcare TomballTomball, TXHospital
Memorial Hermann Hospital SystemHouston, TXHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Premier Provider Health Pa226453127621

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. Mrs Holli Dezaun Waller allows following entities to bill medicare on her behalf.
Entity NameRegional Employee Assistance Program Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1649232984
PECOS PAC ID: 1557260064
Enrollment ID: O20040612000731
Entity NamePremier Provider Health Pa
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1013397066
PECOS PAC ID: 2264531276
Enrollment ID: O20070615000236

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. Mrs Holli Dezaun 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 AddressPractice Location Address
Mrs Holli Dezaun Waller, DO
6326 Stonewood Pointe Ln.,
Houston, TX 77066

Ph: (281) 300-9849		Mrs Holli Dezaun Waller, DO
3700 South Main Street,
Blacksburg, VA 24060

Ph: (540) 953-5445

Reviews and Comments


Family Medicine Doctors in Blacksburg, VA

Dr. Michael Howard Clary, DO
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Medicare: Accepting Medicare Assignments
Practice Location: 3700 S Main St, Suite A, Blacksburg, VA 24060
Phone: 540-443-7187    Fax: 540-443-7182
Jason Le, DO
Family Medicine
Medicare: Medicare Enrolled
Practice Location: 1691 Innovation Dr Ste 2100, Blacksburg, VA 24060
Phone: 540-232-8405    
Pete A. Guerra, M.D.
Family Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 2401 S Main St Ste D, Blacksburg, VA 24060
Phone: 540-418-1910    
Crystal Downer, DO
Family Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 3700 S Main St Ste 1a, Blacksburg, VA 24060
Phone: 540-443-7180    Fax: 540-443-3725
Andrea Lynn Hall, M.D.
Family Medicine
Medicare: Medicare Enrolled
Practice Location: 1645 North Main Street, Blacksburg, VA 24060
Phone: 540-552-1246    Fax: 540-552-1247
Keith Peter Madsen, M.D.
Family Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 1420 N Main St, Blacksburg, VA 24060
Phone: 540-951-8380    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.