MR. MICHAEL LEE WATERS (MD) – Family Medicine Physician, NPI 1477536993

MR. MICHAEL LEE WATERS (MD) is a healthcare provider. based in Macomb, Illinois. specializing in FAMILY PRACTICE. They hold the professional credentials MD. The NPI Number for MR. MICHAEL LEE WATERS (MD) is 1477536993

Main info

Male
30 Years Of Experience
Accepts Medicare Assignment
Name
MR. MICHAEL LEE WATERS (MD)
NPI
1477536993
Phone
(309) 833-1733
Address
505 E GRANT ST
Enumeration Date
29 November 2005
Last Update Date
8 July 2007

Doctor Profile

Medical School Name
UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Secondary Phone
3098334101
Graduation Year
1996 (30 years ago)
PAC ID
9032249883
Group Practice PAC ID
0446140180
Professional Enrollment ID
I20100604000995
Address ID
IL614553313MA525XXSTXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience45
Completeness75
Years active:20State licenses:0Digital endpointsOther names

5,041 FAMILY PRACTICE in IL

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Provider Addresses for MR. MICHAEL LEE WATERS (MD)

  • 505, East Grant Street, Macomb, McDonough County, Illinois, 61455, United States

    SUITE 110

    MACOMB, IL 614553352

    Phone: (309) 833-1733

    Fax: (309) 836-2369

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2010-06-04

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20100604000995IFamily PracticeILTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 61455)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0446140180View full group profile
NameSpecialtyState
-IL
Nurse PractitionerIL
Certified Registered Nurse Anesthetist (Crna)IL
General SurgeryIL
-TN
A N E S T H E S I O L O G YIA
Physician AssistantIL
-IL
Internal Medicine, Cardiovascular Disease (Cardiology), Cardiovascular Disease (Cardiology)WI
Nurse PractitionerIL

Reviews

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Frequently asked questions

Does MR. MICHAEL LEE WATERS (MD) share an NPI with anyone else?
NPI numbers are unique to each provider or organization — MR. MICHAEL LEE WATERS (MD) uses 1477536993.
Does CMS list MR. MICHAEL LEE WATERS (MD) as active?
Yes — MR. MICHAEL LEE WATERS (MD) is active in the NPI listing used on this page.
What is MR. MICHAEL LEE WATERS (MD)'s specialty?
The listing groups MR. MICHAEL LEE WATERS (MD) with Family Medicine Physician. Clinical services aligned with this taxonomy classification.
What address line appears for MR. MICHAEL LEE WATERS (MD)?
MR. MICHAEL LEE WATERS (MD)'s geographic hint is Macomb, Illinois in our summary view.
Why does MR. MICHAEL LEE WATERS (MD) have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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