Robert D Wallace, MD

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

27658 Issued in TN

Practice address

1068 Cresthaven Rd Ste 500
Memphis, TN 38119

Phone

(901) 866-8525

NPI assigned

Apr 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 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Plastic and Reconstructive Surgery

Education

Jefferson Medical College of Thomas Jefferson University, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Memorial Hospital Hospital, Memphis, TN, CCN 440048

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• MS PPO C-SNP
• MS PPO D-SNP
• MS PPO

Interoperability endpoints

• Direct secure messaging: rwallace32554@mlh.direct-ci.com

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.

• Wallace Plastic Surgery Group, PLLC

  • Plastic Surgery Physician
  • Memphis, TN
  • NPI 1497473557
  Medicare reassignment NPD Authorized official
• St Jude Children'S Research Hospital, Inc.

  • Pediatrics Physician
  • Memphis, TN
  • NPI 1306335088
  Medicare reassignment NPD
• Ut Medical Group Inc

  • Multi-Specialty Clinic/Center
  • Memphis, TN
  • NPI 1780676650

  Plastic and Reconstructive Surgery

  Medicare reassignment NPD
• Ut Medical Group, Inc.

  • Ophthalmology Physician
  • Memphis, TN
  • NPI 1326919200
  NPD

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

• Baptist Memorial Hospital

  • General Acute Care Hospital
  • Memphis, TN
  • NPI 1578527172
  Care Compare affiliation

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548979200000",
    "number": "1023075637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 UNION AVE STE 700",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043641",
            "telephone_number": "901-866-8622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1068 CRESTHAVEN RD STE 500",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38119",
            "telephone_number": "901-866-8525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1910 Nonconnah Blvd",
            "address_2": "Suite 120",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381322113",
            "country_code": "US",
            "telephone_number": "901-448-2300",
            "fax_number": "901-448-6657",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ROBERT",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2019-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TN",
            "license": "27658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130322001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00118676",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3804973",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Landon J Wallace, O.D.
• Lee S. Wallace, MS, RD, LDN, FADA
• Madison Wallace
• Marisha Wallace
• Michael C Wallace, MD
• Sharon Denice Wallace
• Terri Wallace, FNP
• William S Wallace, FNP
• Gwendolyn Felicia Waller-Moore, FNP
• Benjamin R Waller III, MD

• Plastic and Reconstructive Surgery Physician in Memphis, TN
• Providers in Memphis, TN by specialty
• Plastic and Reconstructive Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.