Paul Wesley Wallace, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A049918 Issued in CA

Practice address

8920 Wilshire Blvd
Suite 327
Beverly Hills, CA 90211-2007

Phone

(310) 652-8460

Fax

(310) 652-8499

NPI assigned

Nov 19, 2005

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 1

Medicare fee-for-service enrollment

Enrolled in CA

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

DermatologyAlso: Plastic and Reconstructive Surgery, Sports Medicine

Education

University of Oklahoma College of Medicine, 1989

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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 Medical Group, Inc

  • Procedural Dermatology Physician
  • Beverly Hills, CA
  • NPI 1104047596
  Medicare reassignment NPD Authorized official
• Wallace Medical Group

  • Dermatology Physician
  • Beverly Hills, CA
  • NPI 1154422343
  NPD Authorized official

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

{
    "created_epoch": "1132358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192492800000",
    "number": "1063494474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8920 WILSHIRE BLVD",
            "address_2": "SUITE 327",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902112007",
            "telephone_number": "310-652-8460",
            "fax_number": "310-652-8499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8920 WILSHIRE BLVD",
            "address_2": "SUITE 327",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902112007",
            "telephone_number": "310-652-8460",
            "fax_number": "310-652-8499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "PAUL",
        "middle_name": "WESLEY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-19",
        "last_updated": "2007-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A049918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A499180",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wallace & Lee Infusion Center - a Medical Corporation
• Wallace Medical Group
• Wallace Medical Group, Inc
• Daniel J Wallace, M.D.
• Melanie L. Wallace, AMFT
• Deborah Wallach, FNP-BC, OCN, PMN
• Megan Waller, RN
• Cameron Walsh
• Eileen P Walsh, MSN,FNP
• Walter a Rogoff MD Inc

• Dermatology Physician in Beverly Hills, CA
• Providers in Beverly Hills, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; 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.