B Jeffrey Wallis MD PA

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

B JEFFREY WALLIS MD PA

Doing business as

Advanced Gastroenterology Associates

Practice address

6152 W Corporate Oaks Dr
Crystal River, FL 34429-8722

Phone

(352) 564-3900

Fax

(352) 564-3903

NPI assigned

Sep 26, 2011

Last updated

Aug 7, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Barrett Jeffrey Wallis, M.D.NPI 1740220938

Title

Owner

Phone

(352) 400-8000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Advanced Gastroenterology Associates Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DFIFBA

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Barrett Jeffrey Wallis, MD

  • Gastroenterology Physician
  • Crystal River, FL
  • NPI 1740220938
  Medicare reassignment Care Compare group NPD Authorized official
• Joshua Taylor Williams, PA-C

  • Physician Assistant
  • Fort Collins, CO
  • NPI 1891414207

  FL

  Medicare reassignment Care Compare group
• Joshua J Wright, CRNA

  • Certified Registered Nurse Anesthetist
  • Clovis, NM
  • NPI 1467558585

  FL

  Medicare reassignment
• Dennis Anthony Niner, M.D.

  • Obstetrics & Gynecology Physician
  • Brooksville, FL
  • NPI 1629031091
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344297600000",
    "number": "1003199076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6152 W CORPORATE OAKS DR",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344298722",
            "telephone_number": "352-564-3900",
            "fax_number": "352-564-3906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6152 W CORPORATE OAKS DR",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344298722",
            "telephone_number": "352-564-3900",
            "fax_number": "352-564-3903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "B JEFFREY WALLIS MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-26",
        "last_updated": "2012-08-07",
        "status": "A",
        "authorized_official_last_name": "WALLIS",
        "authorized_official_first_name": "BARRETT",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-400-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001690000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Gastroenterology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maria Antonetti, LPTA13089
• Lauren Arnold, PTA
• Arthritis & Osteoporosis Clinics of Florida, Inc.
• Anthony Asaro, RPH
• Jami Austin
• Lisa M Back
• Stacy Lynn Bahner, CRNA
• Glendora Y Baker
• Richard Baker
• Ryte Baksiene, M.D.

• Gastroenterology Physician in Crystal River, FL
• Providers in Crystal River, FL by specialty
• Gastroenterology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.