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RICHARD WALTERS
NPI 1154013829
Student in an Organized Health Care Education/Training Program in Jonesboro, AR

Active since May 22, 2023PECOS EnrolledAccepts Medicare Assignment
4800 E JOHNSON AVE, JONESBORO, AR 72405(870) 936-1000 Get Directions Write a Review

NPPES record last updated: May 22, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Richard Walters NPPES

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

RICHARD WALTERS (NPI 1154013829) is an individual student in an organized health care education/training program in Jonesboro, Arkansas and active in the NPI registry since May 2023. He is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1154013829
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameRICHARD WALTERS
Location Address4800 E JOHNSON AVEJonesboro, AR 72405-8413
Mailing Address4909 Reserve Blvd Apt C202Jonesboro, AR 72405-8358
Phone(870) 936-1000
Sole ProprietorYes
Medical School CMSOtherGraduated 2023
Enumeration DateMay 22, 2023
NPPES CertifiedMay 22, 2023
✔ NPI 1154013829 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
4800 E JOHNSON AVE, Jonesboro, AR 72405
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Richard Walters is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2668832767
PECOS Enrollment IDI20250826004842
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

2

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

Northeast Arkansas Clinic Charitable Foundation, Inc.
Same address
Radiology, Mobile Mammography
4800 E JOHNSON AVE
Jonesboro, AR 72405
  • Reassigned Medicare billing, Arkansas enrollment
  • 439 clinicians in this Medicare group
NPI 1417721689 (870) 936-8000
Connectcare Hospitalists, LLC.
306 mi
Hospitalist
2340 E MEYER BLVD, BUILDING #2 SUITE 348
Kansas City, MO 64132
  • Reassigned Medicare billing, Missouri enrollment
  • 20 clinicians in this Medicare group
NPI 1740718675 (816) 394-9044

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

Other Providers at the Same Location NPPES 20

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

DR. REFAYAT AHSEN MD
Internal Medicine
4800 E JOHNSON AVE
JONESBORO, AR 72405
Craighead County (865) 684-0799
JARRYD A DEMPSEY PT
Physical Therapist
4800 E JOHNSON AVE
JONESBORO, AR 72405
Craighead County (870) 936-8000
DR. FAHAD KHAN DO
Student in an Organized Health Care Education/Training Program
4800 E JOHNSON AVE
JONESBORO, AR 72405
Craighead County (870) 936-1000
WILLIAM B ROTH DO
Hospitalist
4800 E JOHNSON AVE
JONESBORO, AR 72405
Craighead County (870) 936-1000
SAMUEL DAVID MARTIN DO
Student in an Organized Health Care Education/Training Program
4800 E JOHNSON AVE
JONESBORO, AR 72405
Craighead County (870) 936-1000
RANYA HAIDAR AL-KHAFAJI MD
Student in an Organized Health Care Education/Training Program
4800 E JOHNSON AVE
JONESBORO, AR 72405
Craighead County (870) 936-1000
KATIE JUSTINE CRISMAN CRNA
Nurse Anesthetist, Certified Registered
4800 E JOHNSON AVE
JONESBORO, AR 72405
Craighead County (870) 936-1000
MR. PHILLIP WAYNE STOKES JR. FNP-C
Nurse Practitioner (Family)
4800 E JOHNSON AVE
JONESBORO, AR 72405
Craighead County (870) 936-8000

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 Richard Walters's NPI number?

The NPI number for Richard Walters is 1154013829. It was assigned to this individual provider in the NPPES registry on May 22, 2023.

Where is Richard Walters located?

Richard Walters practices at 4800 E Johnson Ave, Jonesboro, AR 72405. The listed phone number is (870) 936-1000.

What is Richard Walters's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Richard Walters enrolled in Medicare?

Yes. Richard Walters is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Richard Walters's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Richard Walters reassigns Medicare benefits to 2 organizations: Northeast Arkansas Clinic Charitable Foundation, Inc. (Jonesboro, AR) and Connectcare Hospitalists, LLC. (Kansas City, MO). 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 Richard Walters's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Richard Walters was last updated on May 22, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.