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CHARLES WALLER MD
NPI 1306841341
General Practice in Benton, KY

Active since June 16, 2005PECOS EnrolledAccepts Medicare Assignment
218 BASS LN, BENTON, KY 42025(270) 556-3239(270) 354-5865 Get Directions Write a Review

NPPES record last updated: February 1, 2017. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Charles Waller Md NPPES

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

CHARLES WALLER MD (NPI 1306841341) is an individual general practice provider in Benton, Kentucky, licensed in Kentucky (29738) and active in the NPI registry since June 2005. He is enrolled in Medicare PECOS, is affiliated with Jackson Purchase Medical Center, and is a graduate of University Of Kentucky College Of Medicine (1992).

NPPES Registry Identity

NPI1306841341
Entity TypeIndividualMale
Primary Taxonomy208D00000X
Provider Legal NameCHARLES WALLERCredential: MD
Location Address218 BASS LNBenton, KY 42025-5824
Mailing Address218 Bass LnBenton, KY 42025-5824 · (270) 556-3239 · Fax (270) 354-5865
Phone(270) 556-3239
Fax(270) 354-5865
Sole ProprietorNo
Medical School CMSUniversity Of Kentucky College Of MedicineGraduated 1992
Enumeration DateJune 16, 2005
Last NPPES UpdateFebruary 1, 2017
✔ NPI 1306841341 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in KY · 29738
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedEmergency MedicineTaxonomy 207P00000X · License 29738 (KY)
218 BASS LN, Benton, KY 42025
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Other Identifiers 6

Medicare PIN0933213KY
Medicaid4047217TN
Medicare ID-Type Unspecified0924401KY
Medicaid64297385KY
Medicare UPINF72255KY
Medicare PIN0935608KY

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

Charles Waller Md 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 ID244212645
PECOS Enrollment IDI20040601000835
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

3

Medicare enrollment records show Charles Waller reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Trigg County Hospital, Inc
22 mi
Critical Access
254 MAIN ST
Cadiz, KY 42211
  • Reassigned Medicare billing, Kentucky enrollment
  • 105 clinicians in this Medicare group
NPI 1538218680 (270) 522-3215
Hospital Medicine Services Of Tennessee PC
238 mi
Hospitalist
600 WILSON CREEK RD
Lawrenceburg, IN 47025
  • Reassigned Medicare billing, Kentucky enrollment
  • 106 clinicians in this Medicare group
NPI 1528433802 (812) 537-1010
Southeastern Emergency Physicians LLC
270 mi
Emergency Medicine
989 MEDICAL PARK DR
Maysville, KY 41056
  • Reassigned Medicare billing, Kentucky enrollment
  • 828 clinicians in this Medicare group
NPI 1356379382 (606) 759-5311

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 4

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.

Emergency department visit with high level of medical decision making 99285
An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.
148 services140 patients
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only 93010
A routine electrocardiogram (ECG) with 12 leads is a simple, non-invasive test that records the electrical activity of your heart. It helps in identifying heart conditions by detecting irregularities in your heart rhythms. The results are interpreted and a report is provided.
86 services81 patients
Emergency department visit with moderate level of medical decision making 99284
An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
59 services57 patients
Emergency department visit with low level of medical decision making 99283
An emergency department visit for a problem of moderate severity involves immediate medical attention for issues like minor fractures, burns, or high fever. The healthcare team will assess your condition, provide necessary treatment, and may suggest further tests or admission if required.
13 services13 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Jackson Purchase Medical Center

Acute Care Hospitals · Mayfield, KY
2/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number180116
Location1099 Medical Center CircleMayfield, KY 42066 · Graves County
Emergency services Birthing friendly

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 Charles Waller's NPI number?

The NPI number for Charles Waller is 1306841341. It was assigned to this individual provider in the NPPES registry on June 16, 2005.

Where is Charles Waller located?

Charles Waller practices at 218 Bass Ln, Benton, KY 42025. The listed phone number is (270) 556-3239.

What is Charles Waller's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Charles Waller enrolled in Medicare?

Yes. Charles Waller 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 Charles Waller's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Charles Waller reassigns Medicare benefits to 3 organizations: Trigg County Hospital, Inc (Cadiz, KY), Hospital Medicine Services Of Tennessee PC (Lawrenceburg, IN) and Southeastern Emergency Physicians LLC (Maysville, KY). 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 Charles Waller's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Charles Waller affiliated with any hospitals?

According to CMS data, Charles Waller is affiliated with Jackson Purchase Medical Center.

When was this NPI record last updated?

The NPPES record for Charles Waller was last updated on February 1, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.