Carly Lynne Waller, CNM is a medicare enrolled "Advanced Practice Midwife" in Concord, North Carolina. She went to Brody School Of Medicine At East Carolina University and graduated in 2018 and has 6 years of diverse experience with area of expertise as Certified Nurse Midwife (cnm). She is a member of the group practice Novant Medical Group Inc and her current practice location is
9955 Poplar Tent Rd, Concord, North Carolina. You can reach out to her office (for appointments etc.) via phone at
(704) 316-4828.
Carly Lynne Waller is licensed to practice in North Carolina (license number CNM699) 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 1649765389.
Provider's Profile
| Full Name | Carly Lynne Waller |
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| Gender | Female |
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| Speciality | Certified Nurse Midwife (cnm) |
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| Experience | 6 Years |
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| Location | 9955 Poplar Tent Rd, Concord, North Carolina |
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| Accepts Medicare Assignments | Yes. She 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:
- Carly Lynne Waller attended and graduated from Brody School Of Medicine At East Carolina University in 2018
NPI Data:
- NPI Number: 1649765389
- Provider Enumeration Date: 06/26/2018
- Last Update Date: 06/30/2022
Medicare PECOS Information:
- PECOS PAC ID: 9436485398
- Enrollment ID: I20190730003093
Medical Identifiers
Medical identifiers for Carly Lynne Waller such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1649765389 | NPI | - | NPPES |
| CNM04927 | Other | NC | MIDWIFERY JOINT COMMITTEE OF THE STATE OF NORTH CAROLINA |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 367A00000X | Advanced Practice Midwife | CNM699 (North Carolina) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Novant Medical Group Inc | 1153234893 | 1996 |
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. Carly Lynne Waller allows following entities to bill medicare on her behalf.
| Entity Name | Novant Medical Group Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1366409492
PECOS PAC ID: 1153234893
Enrollment ID: O20031121000692 |
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| Entity Name | Novant Medical Group Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1306950282
PECOS PAC ID: 1153234893
Enrollment ID: O20040204001028 |
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| Entity Name | Nmg Health Services Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1396455267
PECOS PAC ID: 4789057753
Enrollment ID: O20230222003037 |
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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. Carly Lynne 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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Carly Lynne Waller, CNM
Po Box 60447,
Charlotte, NC 28260-0447
Ph: () - | Carly Lynne Waller, CNM
9955 Poplar Tent Rd,
Concord, NC 28027-9314
Ph: (704) 316-4828 |
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