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MIA MCKENZIE WALTERS PA-C
NPI 1801687355
Physician Assistant in Glen Carbon, IL

Active since May 14, 2025PECOS Enrolled
1455 VILLAGE CIRCLE DR, GLEN CARBON, IL 62034(618) 477-1810 Get Directions Write a Review

NPPES record last updated: November 24, 2025. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Nov 24, 2025, Nov 11, 2025, May 14, 2025 (3 updates tracked since 2025).

About Mia Mckenzie Walters Pa-c NPPES

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

MIA MCKENZIE WALTERS PA-C (NPI 1801687355) is an individual physician assistant in Glen Carbon, Illinois, licensed in Missouri (2025038815) and active in the NPI registry since May 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1801687355
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMIA MCKENZIE WALTERSCredential: PA-C
Location Address1455 VILLAGE CIRCLE DRGlen Carbon, IL 62034-4321
Mailing Address6420 Clayton RdSaint Louis, MO 63117-1811 · (314) 768-8360
Phone(618) 477-1810
Sole ProprietorYes
Medical School CMSOtherGraduated 2025
Enumeration DateMay 14, 2025
Last NPPES UpdateNovember 24, 20253 updates tracked since enumeration
NPPES CertifiedNovember 24, 2025
✔ NPI 1801687355 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in MO · 2025038815
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1455 VILLAGE CIRCLE DR, Glen Carbon, IL 62034
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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)

Mia Mckenzie Walters Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1456843010
PECOS Enrollment IDI20251121002764
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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62034 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
$88.44 typical visit price
range $56.28 – $173.35
Typical copayment $22.11 (range $14.07 – $43.33)
Most-billed visit code 99203
Established Patient
$70.42 typical visit price
range $17.51 – $139.99
Typical copayment $17.60 (range $4.37 – $34.99)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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 Mia Walters's NPI number?

The NPI number for Mia Walters is 1801687355. It was assigned to this individual provider in the NPPES registry on May 14, 2025.

Where is Mia Walters located?

Mia Walters practices at 1455 Village Circle Dr, Glen Carbon, IL 62034. The listed phone number is (618) 477-1810.

What is Mia Walters's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Mia Walters enrolled in Medicare?

Yes. Mia Walters is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Mia Walters was last updated on November 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months 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.