MRS. HOLLI DEZAUN WALLER D.O.
NPI 1053622167
Family Medicine in Blacksburg, VA

Q: What is Holli Waller's NPI number?

The NPI number for Holli Waller is 1053622167. It was assigned to this individual provider in the NPPES registry on June 24, 2010. The provider is also known as Holli Dezaun Holman.

Q: What is Holli Waller's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Holli Waller was last updated on June 24, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 24, 2010PECOS Enrolled

3700 SOUTH MAIN STREET, BLACKSBURG, VA 24060(540) 953-5445(540) 953-5453 Get Directions Write a Review

NPPES record last updated: June 24, 2010. Verified against the NPPES registry weekly; last sync: October 18, 2026.

On this page

About Mrs. Holli Dezaun Waller D.o. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. HOLLI DEZAUN WALLER D.O. (NPI 1053622167) is an individual family medicine provider in Blacksburg, Virginia, licensed in Virginia (0116022785) and active in the NPI registry since June 2010. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053622167

Entity TypeIndividualFemale

Primary Taxonomy207Q00000X

Provider Legal NameMRS. HOLLI DEZAUN WALLERCredential: D.O.

Location Address3700 SOUTH MAIN STREETBlacksburg, VA 24060

Mailing Address6326 Stonewood Pointe Ln.Houston, TX 77066 · (281) 300-9849

Phone(540) 953-5445

Fax(540) 953-5453

Sole ProprietorYes

Enumeration DateJune 24, 2010

✔ NPI 1053622167 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in VA · 0116022785

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

3700 SOUTH MAIN STREET, Blacksburg, VA 24060

Open in Google Maps ↗

Other Names 1

Former Name (1)Holli Dezaun Holman

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Superior HealthPlan, Ambetter Health, Blue Cross and Blue Shield of Texas and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Holli Dezaun Waller D.o. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Holli Waller reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Regional Employee Assistance Program Inc.

966 mi

Family Medicine

2704 N GALLOWAY AVE, SUITE 103
Mesquite, TX 75150

Reassigned Medicare billing, Texas enrollment
318 clinicians in this Medicare group

NPI 1215348487 (214) 660-2500

Premier Provider Health PA

972 mi

Internal Medicine

9301 N CENTRAL EXPY STE 340
Dallas, TX 75231

Reassigned Medicare billing, Texas enrollment
32 clinicians in this Medicare group

NPI 1235280496 (214) 466-2828

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 11

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Management of oxygen chamber therapy 99183

Oxygen chamber therapy involves breathing pure oxygen in a pressurized room or tube. It's used to treat various conditions like wounds that won't heal due to diabetes or radiation injury. In this therapy, your body's tissues get more oxygen to promote healing and fight infection.

375 services11 patients

Removal of skin and tissue, 20.0 sq cm or less 11042

This procedure involves the surgical removal of skin and tissue, up to 20.0 square cm in size. It's often performed to treat conditions like skin cancer or to remove moles, warts, and other skin lesions. The area is numbed and the unwanted tissue is carefully cut out.

358 services62 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

126 services51 patients

Removal of muscle and/or tissue, 20.0 sq cm or less 11043

This procedure involves the surgical removal of a specified area (20.0 sq cm or less) of muscle and/or tissue. It's typically done to treat conditions like tumors, infections, or injuries. Local or general anesthesia ensures comfort. Recovery time varies.

87 services18 patients

Removal of skin and tissue, each additional 20.0 sq cm or less 11045

This procedure involves the removal of skin and tissue, typically due to disease, injury, or abnormal growth. Each session removes an area of 20.0 square cm or less. It's performed by a trained professional and may require multiple sessions for larger areas.

87 services15 patients

Removal of bone, 20.0 sq cm or less 11044

The procedure involves the surgical removal of a section of bone, up to 20.0 square cm in size. This may be necessary due to various reasons such as injury, infection, or to treat a disease. The process aims to alleviate pain, enhance mobility, or prevent the spread of disease.

84 services13 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

74 services44 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

40 services40 patients

Removal of tissue from wound, 20.0 sq cm or less 97597

This procedure involves the careful removal of damaged or infected tissue from a wound that's 20.0 square cm or less. It's done to promote healing and prevent further infection. The process is carried out under local anesthesia, ensuring minimal discomfort.

38 services19 patients

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

33 services32 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

18 services18 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 24060 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$86.88 typical visit price

range $56.19 – $170.30

Typical copayment $21.72 (range $14.04 – $42.57)

Most-billed visit code 99203

Established Patient

$99.13 typical visit price

range $18.07 – $138.91

Typical copayment $24.78 (range $4.51 – $34.72)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. KRISTIE LYNN JACKSON NP

Nurse Practitioner (Family)

3700 SOUTH MAIN STREET
BLACKSBURG, VA 24060

Montgomery County (540) 953-5385

ABEERA HASSAN MBBS

Student in an Organized Health Care Education/Training Program

3700 SOUTH MAIN STREET
BLACKSBURG, VA 24060

Montgomery County (540) 953-5445

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Holli Waller's NPI number?

The NPI number for Holli Waller is 1053622167. It was assigned to this individual provider in the NPPES registry on June 24, 2010. The provider is also known as Holli Dezaun Holman.

Where is Holli Waller located?

Holli Waller practices at 3700 South Main Street, Blacksburg, VA 24060. The listed phone number is (540) 953-5445.

What is Holli Waller's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Holli Waller enrolled in Medicare?

Yes. Holli Waller is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Holli Waller's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Holli Waller reassigns Medicare benefits to 2 organizations: Regional Employee Assistance Program Inc. (Mesquite, TX) and Premier Provider Health PA (Dallas, TX). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Holli Waller's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Holli Waller accept?

Health plans from Ambetter Health, Ambetter from Superior HealthPlan, Blue Cross and Blue Shield of Texas and WellPoint list Holli Waller as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Holli Waller was last updated on June 24, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.