Robert Alan Wales, MD, FACC

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

M-8366 Issued in ID

Practice address

2315 8TH St Grade
Lewiston, ID 83501-7301

Phone

(509) 455-8820

Fax

(509) 227-7070

NPI assigned

Jul 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Kootenai Health, Inc.

  • Psychiatry Physician
  • Coeur d'Alene, ID
  • NPI 1174661151
  NPD (past)
• Cooper Clinic PA

  • Multi-Specialty Clinic/Center
  • Fort Smith, AR
  • NPI 1154341931
  NPD (past)

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1003820275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 331",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190331",
            "telephone_number": "509-747-2455",
            "fax_number": "509-227-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 8TH ST GRADE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835017301",
            "telephone_number": "509-455-8820",
            "fax_number": "509-227-7070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 W Ironwood Dr",
            "address_2": "214",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838142656",
            "country_code": "US",
            "telephone_number": "208-292-1600",
            "fax_number": "208-292-1610",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "122 W 7th Ave Ste 450",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992042339",
            "country_code": "US",
            "telephone_number": "509-455-8820",
            "fax_number": "509-227-7070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALES",
        "first_name": "ROBERT",
        "middle_name": "ALAN",
        "credential": "MD, FACC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "ID",
            "license": "M-8366",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WA",
            "license": "MD00040353",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRB",
            "identifier": "060064955",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8283913",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806097900",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awales220633@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2315 8th St Grade",
            "city": "Lewiston",
            "state": "ID",
            "country_code": "US",
            "postal_code": "835017301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Edward Angus Vivian, MD
• Elizabeth L Von Bargen, NP
• James F Waham, PCPRC
• William Wainwright, DPT
• Benjamin Bennett Waites, DMD
• Walgreen Co (Walgreens #02679)
• Walgreen Co (Rite Aid #16585)
• Walgreens
• Walla Walla Vamc
• Heath B Walters, PH.D.

• Cardiovascular Disease Physician in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Cardiovascular Disease Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.