James Edwards Wallace Jr., MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD.200134 Issued in LA

Practice address

1135 Expressway Dr
Suite 200 a
Pineville, LA 71360-6698

Phone

(318) 561-9600

Fax

(318) 561-0228

NPI assigned

May 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in LA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Calcasieu Urgent Care LLC

  • Urgent Care Clinic/Center
  • Lake Charles, LA
  • NPI 1467715490
  Medicare reassignment NPD
• Calcasieu Urgent Care, LLC

  • Rural Health Clinic/Center
  • Breaux Bridge, LA
  • NPI 1194482398
  NPD
• Rapides Regional Physician Group Specialty Care, LLC

  • Specialist
  • Alexandria, LA
  • NPI 1043309016
  NPD (past)
• Fayette Medical Center

  • General Acute Care Hospital
  • Fayette, AL
  • NPI 1851323836
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403136000000",
    "number": "1063464006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 EXPRESSWAY DR",
            "address_2": "SUITE 200 A",
            "city": "PINEVILLE",
            "state": "LA",
            "postal_code": "713606698",
            "telephone_number": "318-561-9600",
            "fax_number": "318-561-0228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 EXPRESSWAY DR",
            "address_2": "SUITE 200 A",
            "city": "PINEVILLE",
            "state": "LA",
            "postal_code": "713606698",
            "telephone_number": "318-561-9600",
            "fax_number": "318-561-0228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JAMES",
        "middle_name": "EDWARDS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2014-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD.200134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1627950",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "202768397",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "202768397",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA MILITARY",
            "identifier": "202768397",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Waldron
• Walgreen Co
• Walgreen Co
• Walgreen Co.
• Keith Walker, C.I.T.
• Sandra Fay Waller
• Walmart Pharmacy
• Shamika Walsh, APRN,FNP-C
• Anthony James Walton, CTRS
• Mary Lynn Ward, NP

• Family Medicine Physician in Pineville, LA
• Providers in Pineville, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2014; 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.