Richard Edwin Waller, MD is a medicare enrolled "Family Medicine" physician in Marks, Mississippi. He went to University Of Mississippi School Of Medicine and graduated in 1974 and has 50 years of diverse experience with area of expertise as Family Practice. He is a member of the group practice Delta Medical Foundation and his current practice location is
1024 Martin Luther King Drive, Marks, Mississippi. You can reach out to his office (for appointments etc.) via phone at
(662) 326-3502.
Richard Edwin Waller is licensed to practice in Mississippi (license number 07067) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1821001041.
Physician's Profile
| Full Name | Richard Edwin Waller |
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| Gender | Male |
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| Speciality | Family Practice |
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| Experience | 50 Years |
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| Location | 1024 Martin Luther King Drive, Marks, Mississippi |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Richard Edwin Waller attended and graduated from University Of Mississippi School Of Medicine in 1974
NPI Data:
- NPI Number: 1821001041
- Provider Enumeration Date: 08/15/2006
- Last Update Date: 03/01/2017
Medicare PECOS Information:
- PECOS PAC ID: 5698745420
- Enrollment ID: I20041129000760
Medical Identifiers
Medical identifiers for Richard Edwin Waller such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1821001041 | NPI | - | NPPES |
| 00115098 | Medicaid | MS | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | 07067 (Mississippi) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Delta Medical Foundation | 2163777046 | 8 |
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. Richard Edwin Waller allows following entities to bill medicare on his behalf.
| Entity Name | Delta Medical Foundation |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1508363060
PECOS PAC ID: 2163777046
Enrollment ID: O20180618001135 |
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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. Richard Edwin 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 |
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Richard Edwin Waller, MD
Po Box 289,
Marks, MS 38646-0289
Ph: (662) 326-3500 | Richard Edwin Waller, MD
1024 Martin Luther King Drive,
Marks, MS 38646-0289
Ph: (662) 326-3502 |
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