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WALTER SAMUEL ROSE II
NPI 1720666282
Student in an Organized Health Care Education/Training Program in Jackson, MS

Active since March 29, 2021PECOS Enrolled
3805 CRANE BLVD, JACKSON, MS 39216(662) 207-7268 Get Directions Write a Review

NPPES record last updated: March 29, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Walter Samuel Rose Ii NPPES

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

WALTER SAMUEL ROSE II (NPI 1720666282) is an individual student in an organized health care education/training program in Jackson, Mississippi and active in the NPI registry since March 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1720666282
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameWALTER SAMUEL ROSE II
Location Address3805 CRANE BLVDJackson, MS 39216-3608
Mailing Address3805 Crane BlvdJackson, MS 39216-3608 · (662) 207-7268
Phone(662) 207-7268
Sole ProprietorNo
Enumeration DateMarch 29, 2021
NPPES CertifiedMarch 29, 2021
✔ NPI 1720666282 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.
3805 CRANE BLVD, Jackson, MS 39216
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Walter Samuel Rose Ii 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.

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 Walter Rose's NPI number?

The NPI number for Walter Rose is 1720666282. It was assigned to this individual provider in the NPPES registry on March 29, 2021.

Where is Walter Rose located?

Walter Rose practices at 3805 Crane Blvd, Jackson, MS 39216. The listed phone number is (662) 207-7268.

What is Walter Rose's specialty?

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

Is Walter Rose enrolled in Medicare?

Yes. Walter Rose is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Walter Rose was last updated on March 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.