John Hugh Wallace Jr., FNP-C
Individual provider Active NPI Family Nurse Practitioner · Valdese, NC
NPI 1003296484 · NPPES record last updated May 28, 2021
Key facts
- NPI
- 1003296484
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 246400 (NC)
- Practice address
- 319 Springwood Dr NE
Valdese, NC 28690-8710 - Phone
- (828) 879-8419
- NPI assigned
- Jun 1, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 23
Hospital & facility affiliations 10
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- North Big Horn Hospital District
Practice addresses (Care Compare)
1115 Lane
Lovell, WY 82431-9537
Phone (307) 548-5200
Hospital & facility affiliations
- North Big Horn Hospital District
- Billings Clinic Hospital
- North Big Horn Hospital District
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in NC, TX, WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150911002034 | NC | Practitioner - Nurse Practitioner | 0446567127 | Reassigns benefits to 3 organizations |
| I20190305001248 | TX | Practitioner - Nurse Practitioner | 0446567127 | |
| I20220318001892 | WY | Practitioner - Nurse Practitioner | 0446567127 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 246400 | NC | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Caldwell Memorial Hospital, Inc. | Current |
Accepting new patients | |
| Caldwell Memorial Hospital, Inc. | Current | Accepting new patients | |
| Caldwell Memorial Hospital, Inc | Current | Accepting new patients | |
| Blowing Rock Medical Clinic PR | Current | Accepting new patients | |
| Careconnectmd North Carolina P.C. | Current |
Accepting new patients | |
| North Big Horn Hospital | Current |
Accepting new patients | |
| Caldwell Memorial Hospital, Inc | Current |
Accepting new patients | |
| North Big Horn Hospital District | Current |
Accepting new patients | |
| North Big Horn Hospital District | Current |
Accepting new patients |
Locations
3090 Bristol St
Ste 200
Costa Mesa, CA 92626
Phone (714) 992-1182
8439 Valley Blvd
Blowing Rock, NC 28605
Phone (828) 295-3116
555 S Mangum St
Ste 100
Durham, NC 27701
Phone (323) 545-3659
4355 Hickory Blvd
Ste 1
Granite Falls, NC 28630
Phone (828) 757-8251
4355 Hickory Blvd
Granite Falls, NC 28630
Phone (828) 396-7550
160 River Bend Dr
Ste A
Granite Falls, NC 28630
Phone (828) 757-5042
36 14th Ave NE
Ste 2B
Hickory, NC 28601
Phone (828) 757-5074
270 Pine Mountain Rd
Ste 2
Hudson, NC 28638
Phone (828) 757-6330
322 Mulberry St SW
Ste A
Lenoir, NC 28645
Phone (828) 757-6400
321 Mulberry St SW
Lenoir, NC 28645
Phone (828) 757-5100
1731 Connelly Springs Rd
Lenoir, NC 28645
Phone (828) 728-3362
1115 Lane 12
Lovell, WY 82431
Phone (307) 548-2771
Interoperability endpoints
- jwallace162039@direct.unc.nchie.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 246400 | NC | Yes |
Addresses
Primary practice location
319 Springwood Dr NE
Valdese, NC 28690-8710
Mailing address
319 Springwood Dr NE
Valdese, NC 28690-8710
Other providers in Valdese, NC
- Valdese General Hospital, Inc.
- Lou Vang
- Mai Khue Vang
- Vicki'S Blessing Hands LLC
- Daniel Waksman
- Western Piedmont Oncology, PA
- Marsha Anne Zimmer
All providers in Valdese, NC · Family Nurse Practitioner in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 28, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.