NPIMap

Individual provider Active NPI

Imelda V Wallace, FNP-BC

  • Family Nurse Practitioner
  • El Paso, TX
National Provider Identifier
1003541095
Registry record updated Jul 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2022000137 Issued in TX
Practice address
11860 Vista del Sol Dr Ste 150
El Paso, TX 79936-6128
Phone
(915) 808-4000
NPI assigned
Jul 22, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2022000137 TX Primary

Addresses

Primary practice location

11860 Vista del Sol Dr Ste 150
El Paso, TX 79936-6128

Mailing address

11860 Vista del Sol Dr Ste 150
El Paso, TX 79936-6128
Phone (915) 808-4000

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL https://www.threeoakshospice.com/locations/el-paso/?utm_source=google&utm_medium=organic&utm_campaign=google+my+business

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230725000497 NM Practitioner - Nurse Practitioner 5193185080 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rio Grande Urology PAGroup PAC ID 3476627878, 28 clinicians

Practice addresses (Care Compare)

2545 S Don Roser Dr
Las Cruces, NM 88011-9107
Phone (575) 522-7880

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2022000137TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rio Grande Urology PA CurrentSince Jul 3, 2023 Accepting new patients
Hospice del Norte LLC CurrentSince Jul 24, 2022 Accepting new patients
Joseph a Caplan MD PC PastSince Jul 3, 2023 Accepting new patients

Locations

2545 S Don Roser Dr
Las Cruces, NM 88011
Phone (575) 522-7880

11860 Vista del Sol Dr
Ste 150
El Paso, TX 79936
Phone (915) 808-4000

7420 Remcon Cir
Ste A
El Paso, TX 79912
Phone (915) 225-2023

3100 N Lee Trevino Dr
El Paso, TX 79936
Phone (915) 534-1072

Networks

  • CO HMO D-SNP
  • CO HMO
  • TX HMO D-SNP
  • devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a
  • NM HMO C-SNP
  • TX HMO

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/15467/brand/1/csg/1/fhir/r4
  • Direct secure messaging: imeldawallace@rgu.medalliesdirect.net
  • FHIR API: https://api.platform.athenahealth.com/12922/brand/1/csg/1/fhir/r4

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1658448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658448000000",
    "number": "1003541095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11860 VISTA DEL SOL DR STE 150",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799366128",
            "telephone_number": "915-808-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11860 VISTA DEL SOL DR STE 150",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799366128",
            "telephone_number": "915-808-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "IMELDA",
        "middle_name": "V",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-22",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "2022000137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.threeoakshospice.com/locations/el-paso/?utm_source=google&utm_medium=organic&utm_campaign=google+my+business",
            "affiliation": "N",
            "endpointDescription": "TOH website",
            "address_1": "11860 Vista Del Sol Dr Ste 150",
            "city": "El Paso",
            "state": "TX",
            "country_code": "US",
            "postal_code": "799366128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.