Charles Waller, MD - Medicare General Practice in Benton, KY

Charles Waller, MD is a medicare enrolled "General Practice" physician in Benton, Kentucky. His current practice location is 218 Bass Ln, Benton, Kentucky. You can reach out to his office (for appointments etc.) via phone at (270) 556-3239.

Charles Waller is licensed to practice in Kentucky (license number 29738) 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 1306841341.

Contact Information

Charles Waller, MD
218 Bass Ln,
Benton, KY 42025-5824
(270) 556-3239
(270) 354-5865



Physician's Profile

Full NameCharles Waller
GenderMale
SpecialityGeneral Practice
Location218 Bass Ln, Benton, Kentucky
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1306841341
  • Provider Enumeration Date: 06/16/2005
  • Last Update Date: 02/01/2017
  Medicare PECOS Information:
  • PECOS PAC ID: 0244212645
  • Enrollment ID: I20040601000835

Medical Identifiers

Medical identifiers for Charles Waller such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1306841341NPI-NPPES
4047217MedicaidTN
64297385MedicaidKY

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
208D00000XGeneral Practice 29738 (Kentucky)Primary
207P00000XEmergency Medicine 29738 (Kentucky)Secondary

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. Charles Waller allows following entities to bill medicare on his behalf.
Entity NameTrigg County Hospital, Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1538218680
PECOS PAC ID: 5193620805
Enrollment ID: O20031205000118

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Entity NameSoutheastern Emergency Physicians Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1356379382
PECOS PAC ID: 2466364997
Enrollment ID: O20050302000285

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Entity NameApp Of Kentucky Ed, Pllc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1497157341
PECOS PAC ID: 0749502862
Enrollment ID: O20141201000389

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Entity NameHospital Medicine Services Of Tennessee Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1528433802
PECOS PAC ID: 9234432881
Enrollment ID: O20160803001623

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› Verified 8 days ago

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. Charles 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
Charles Waller, MD
218 Bass Ln,
Benton, KY 42025-5824

Ph: (270) 556-3239
Charles Waller, MD
218 Bass Ln,
Benton, KY 42025-5824

Ph: (270) 556-3239

News Archive

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Read more News

› Verified 8 days ago


General Practice Doctors in Benton, KY


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