Richard Austin Wallace, MD

Primary specialty

Otology & Neurotology PhysicianTaxonomy code 207YX0901X

License

WV11648 Issued in WV

Practice address

1306 Kanawha Blvd E
Charleston, WV 25301-3001

Phone

(304) 343-4371

Fax

(304) 353-0215

NPI assigned

Jun 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/17503/brand/1/csg/1/fhir/r4
• FHIR API: https://fhir-usa.unify.chbase.com/org/charles-8f0482a8

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.

• Charleston Surgical Hospital Healthcare Group, PLLC

  • Surgery Physician
  • Charleston, WV
  • NPI 1285131144
  NPD (past)
• Charleston Surgical Hospital, LLC

  • General Acute Care Hospital
  • Charleston, WV
  • NPI 1104904143
  NPD (past)
• Eye & Ear Clinic Physicians Inc

  • Customized Equipment (DME)
  • Charleston, WV
  • NPI 1427133826
  NPD (past)
• Eye and Ear Clinic Physicians, Inc

  • Otolaryngology/Facial Plastic Surgery Physician
  • Charleston, WV
  • NPI 1043222961
  NPD (past)

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355270400000",
    "number": "1013957034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 KANAWHA BLVD E",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253013001",
            "telephone_number": "304-343-4371",
            "fax_number": "304-353-0215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 KANAWHA BLVD E",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253013001",
            "telephone_number": "304-343-4371",
            "fax_number": "304-353-0215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "RICHARD",
        "middle_name": "AUSTIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2012-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "WV",
            "license": "WV11648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1013957034",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010107500",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Priscilla Joyce Walkup, C.R.N.A.
• Alyssa Wallace, PHARMD
• Cameron Blake Wallace, CRNA
• Presley Wallace
• Rebecca Wallace
• Wanda Wallace
• Edna Wallen
• Roseanna Waller
• Stacey Waller, PH.D.
• Brooke Leann Walls

• Otology & Neurotology Physician in Charleston, WV
• Providers in Charleston, WV by specialty
• Otology & Neurotology Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2012; 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.