BENJAMIN R III WALLER (MD) – Interventional Cardiology Physician, NPI 1013974062
Interventional Cardiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
757 CARDIOVASCULAR DISEASE (CARDIOLOGY) in TN
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Provider Addresses for BENJAMIN R III WALLER (MD)
Le Bonheur Children's Hospital, 848, Adams Avenue, Medical District, Dixie Homes, Memphis, Shelby County, Tennessee, 38103, United States
MEMPHIS, TN 381032816
Phone: (901) 287-5594
Type: Mailing
North Dunlap Street, Medical District, Dixie Homes, Memphis, Shelby County, Tennessee, 38163, United States
MEMPHIS, TN 38105
Phone: (901) 287-7337
Fax: (901) 287-4646
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 28 Open Payments records for all available years, with a total value of $16,696.
Total Amount is formed as General ($16,696) + Research ($0) + Ownership ($0) = $16,696.
Last reported payment date: 2024-11-11 • Largest payer in this snapshot: W. L. Gore & Associates, Inc. ($15,591).
Total Amount
$16,696
General + Research + Ownership
Payments
28
Total payment records
General Amount
$16,696
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-11
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2015-12-05
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 |
|---|---|---|---|---|
| I20101028000743 | I | Pediatric Medicine | TN | TBD |
| I20151205000108 | I | Cardiovascular Disease (Cardiology) | MS | 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 38103)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| A N E S T H E S I O L O G Y | MS | |
| - | TN | |
| - | TN | |
| - | TN | |
| - | TN | |
| Diagnostic Radiology | TN | |
| Nephrology, Pediatric Medicine, Nephrology, Pediatric Medicine | TX | |
| Internal Medicine, Nephrology, Pediatric Medicine, Nephrology | TN | |
| Pediatric Medicine, Nephrology | TX | |
| - | TN |
Reviews
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