RICHARD EDWIN WALLER M.D.
NPI 1821001041
Family Medicine in Marks, MS
About Richard Edwin Waller M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
RICHARD EDWIN WALLER M.D. (NPI 1821001041) is an individual family medicine provider in Marks, Mississippi, licensed in Mississippi (07067) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS, is affiliated with Baptist Memorial Hospital North Ms, and is a graduate of University Of Mississippi School Of Medicine (1974).
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 3
Accepted Insurance
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 Edwin Waller M.d. 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.
Medicare Billing Reassignment
Medicare enrollment records show Richard Waller reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Marks, MS 38646
- Reassigned Medicare billing, Mississippi enrollment
- 9 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Baptist Memorial Hospital North Ms
Acute Care Hospitals · Oxford, MSPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 38646 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Referred Medical Equipment & Supplies CMS DME claims 41
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
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 Waller's NPI number?
The NPI number for Richard Waller is 1821001041. It was assigned to this individual provider in the NPPES registry on August 15, 2006.
Where is Richard Waller located?
Richard Waller practices at 1024 Martin Luther King Drive, Marks, MS 38646. The listed phone number is (662) 326-3502.
What is Richard Waller's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Richard Waller enrolled in Medicare?
Yes. Richard 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 organization bills Medicare for Richard Waller's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Richard Waller reassigns Medicare benefits to Delta Medical Foundation (Marks, MS). The 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 Waller's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Richard Waller accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter of Alabama and Ambetter of Tennessee and 2 other insurers list Richard 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.
Is Richard Waller affiliated with any hospitals?
According to CMS data, Richard Waller is affiliated with Baptist Memorial Hospital North Ms.
When was this NPI record last updated?
The NPPES record for Richard Waller was last updated on March 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.
# Richard Edwin Waller, M.D. · NPI 1821001041
Family Medicine physician in Marks, Mississippi. Individual provider, active in the CMS NPPES registry since August 15, 2006.
## Identity
- **NPI:** 1821001041 (Entity type: Individual)
- **Enumerated:** August 15, 2006
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **State license:** 07067 (Mississippi)
- **Sole proprietor:** No
## Practice location
- **Address:** 1024 MARTIN LUTHER KING DRIVE, Marks, MS 38646-0289
- **Phone:** (662) 326-3502 · **Fax:** (662) 326-2555
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Delta Medical Foundation (NPI 1720585490, Marks, MS), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of Mississippi School Of Medicine, class of 1974
## Record status
- **NPPES last updated:** March 1, 2017
- **Other identifiers:** Medicaid 00115098 (MS); Medicare UPIN C47952 (MS); Medicare ID-Type Unspecified 080000562 (MS)
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Source: [NPI Profile](https://npiprofile.com/npi/1821001041) · Data from the CMS NPPES public registry.