Max Joseph Wallack

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

ME176656 Issued in FL

Practice address

655 W 8TH St
Jacksonville, FL 32209-6511

Phone

(774) 270-0554

NPI assigned

Apr 13, 2020

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

Medicare fee-for-service enrollment

Enrolled in FL

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

Diagnostic Radiology

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Josephs Diagnostic Center LLCGroup PAC ID 3779484928, 89 clinicians

University of Florida Jacksonville Physicians, Inc.Group PAC ID 9133025869, 908 clinicians

Baycare Outpatient Imaging LLCGroup PAC ID 3577804087, 90 clinicians

Radiology Imaging Associates LLCGroup PAC ID 2466342803, 182 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Shands Jacksonville Hospital, Jacksonville, FL, CCN 100001

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mwallack599640@direct.shands.ufl.edu

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.

• University of Florida Jacksonville Physicians, Inc.

  • Internal Medicine Physician
  • Jacksonville, FL
  • NPI 1144276452

  Diagnostic Radiology

  Medicare reassignment Care Compare group NPD
• Radiology Imaging Associates, LLC

  • Diagnostic Radiology Physician
  • Daytona Beach, FL
  • NPI 1063400729
  Medicare reassignment Care Compare group
• Baycare Outpatient Imaging LLC

  • Diagnostic Radiology Physician
  • Valrico, FL
  • NPI 1417423377
  Care Compare group
• St Josephs Diagnostic Center LLC

  dba BayCare Outpatient Imaging

  • Diagnostic Radiology Physician
  • Tampa, FL
  • NPI 1558342998
  Care Compare group
• University of Florida Jacksonville Physicians Inc

  • Diagnostic Radiology Physician
  • Jacksonville, FL
  • NPI 1326208695
  NPD
• University of Florida Jacksonville Physicians, Inc.

  dba UF Health Imaging Center-Baymeadows

  • Physiological Laboratory
  • Jacksonville, FL
  • NPI 1831800952
  NPD

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

• Shands Jacksonville Medical Center Inc

  • Urgent Care Clinic/Center
  • Jacksonville, FL
  • NPI 1144962408

  Hospital

  Care Compare affiliation
• Shands Jacksonville Medical Center Inc

  dba Shands Jacksonville

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1821186313
  Care Compare affiliation

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

{
    "created_epoch": "1586736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1043839814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3580 PALL MALL DR APT 2604",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322575486",
            "telephone_number": "774-270-0554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 W 8TH ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096511",
            "telephone_number": "774-270-0554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACK",
        "first_name": "MAX",
        "middle_name": "JOSEPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-13",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME176656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phillip Tyler Wallace, APRN
• Ricky Wallace
• Shanthalitta Seals Wallace, LMHC
• Taylor K Wallace, CNA
• Terrica Diane Wallace, PHARMD.
• Darci Waller
• John Waller
• Thomas Waller, MD
• Andrew Wallin, LMHC
• Erica C Walling, PT

• Diagnostic Radiology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Diagnostic Radiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; 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.