Douglas C Wallace, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35.049780 Issued in OH

Practice address

4072 Gantz Rd
Grove City, OH 43123-4816

Phone

(614) 875-0011

Fax

(614) 539-7287

NPI assigned

Jun 5, 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 names 1

• Douglas Craig Wallace Other name

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: douglas.wallacemd.p21@direct.ahni.nextgenshare.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.

• American Health Network of Ohio, LLC

  • Family Medicine Physician
  • Columbus, OH
  • NPI 1386675544
  Medicare reassignment NPD
• American Health Network of Ohio, LLC

  • Family Medicine Physician
  • Westerville, OH
  • NPI 1245279744
  NPD (past)
• American Health Network of Ohio, LLC

  • Family Medicine Physician
  • Hilliard, OH
  • NPI 1699706879
  NPD (past)

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785110400000",
    "number": "1063451144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4072 GANTZ RD",
            "city": "GROVE CITY",
            "state": "OH",
            "postal_code": "431234816",
            "telephone_number": "614-875-0011",
            "fax_number": "614-539-7287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4072 GANTZ RD",
            "city": "GROVE CITY",
            "state": "OH",
            "postal_code": "431234816",
            "telephone_number": "614-875-0011",
            "fax_number": "614-539-7287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DOUGLAS",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.049780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOUGLAS",
            "last_name": "WALLACE",
            "middle_name": "CRAIG",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Samuel Kevin Wagner, DO
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Jamilah Renee Walker, MASSAGE THERAPY
• Stephen Stockton Wallace, DC
• Timothy J Walter, M.D.
• Amanda Walters, LPC
• Christine Walters
• Gabrielle Walton, RN

• Family Medicine Physician in Grove City, OH
• Providers in Grove City, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.