MR. RICHARD KEITH WALLER (APRN) – Nurse Practitioner, NPI 1215770516
Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
14,984 NURSE PRACTITIONER in OH
Provider Addresses for MR. RICHARD KEITH WALLER (APRN)
11135 Montgomery Rd
Cincinnati, OH 452492338
Phone: (513) 791-7572
Fax: (513) 791-8240
Type: Location
1 MEDICAL VILLAGE DRIVE
EDGEWOOD, KY 410173403
Phone: (859) 757-2927
Fax: (859) 341-0203
Type: Mailing
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: 2025-12-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20240904003436 | I | Nurse Practitioner | OH | TBD |
| I20251202003196 | I | Nurse Practitioner | KY | TBD |
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.
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 45249)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| N E P H R O L O G Y | OH | |
| N E P H R O L O G Y | KY | |
| Internal Medicine, Nephrology | OH | |
| N E P H R O L O G Y | OH | |
| N E P H R O L O G Y | OH | |
| Nephrology, Internal Medicine | MI | |
| N E P H R O L O G Y | OH | |
| - | OH | |
| Nephrology, Internal Medicine | OH | |
| N E P H R O L O G Y | OH |
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