Graham Wilson Wallace, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

DR.0068264 Issued in CO

Practice address

777 Bannock St
Denver, CO 80204-4597

Phone

(303) 643-6494

Fax

(303) 602-4168

NPI assigned

Dec 29, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CO, NY, FL3 enrollments

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 3

Specialty

Diagnostic Radiology

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Denver Health and Hospital AuthorityGroup PAC ID 4688583578, 830 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• NYU Langone Hospitals Hospital, New York, NY, CCN 330214
• Denver Health & Hospital Authority Hospital, Denver, CO, CCN 060011
• Long Island Community Hospital Hospital, Patchogue, NY, CCN 330141

Merit-based Incentive Payment System (MIPS)

Final score

96.65 of 100Reported as group

Quality

92.15

Promoting interoperability

100

Improvement activities

40

Cost

80.02

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gwallace267771@direct.dhha.org

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.

• Denver Health and Hospital Authority

  • General Practice Physician
  • Denver, CO
  • NPI 1477569838
  Medicare reassignment Care Compare group NPD
• New York University

  dba NYU Faculty Group Practice

  • Cardiovascular Disease Physician
  • Boynton Beach, FL
  • NPI 1285826438

  CO, NY

  Medicare reassignment Care Compare group NPD
• Denver Health and Hospital Authority

  • Psychiatric Hospital Unit
  • Denver, CO
  • NPI 1689624942
  NPD
• New York University

  dba NYU Langone Ambulatory Care Chelsea

  • Physical Medicine & Rehabilitation Physician
  • Boynton Beach, FL
  • NPI 1104787613
  NPD

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

• Denver Health and Hospital Authority

  dba Denver Health East Grand Community Clinic & Emergency Center

  • Emergency Care Clinic/Center
  • Winter Park, CO
  • NPI 1467762435

  Hospital

  Care Compare affiliation
• Denver Health and Hospital Authority

  • General Acute Care Hospital
  • Denver, CO
  • NPI 1689624686
  Care Compare affiliation
• Denver Health and Hospital Authority

  • Psychiatric Hospital Unit
  • Denver, CO
  • NPI 1689624942
  Care Compare affiliation
• NYU Langone Hospitals

  dba NYU Langone Hospitals - Suffolk

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Patchogue, NY
  • NPI 1013724061

  Hospital

  Care Compare affiliation
• NYU Langone Hospitals

  • Rehabilitation Hospital Unit
  • New York, NY
  • NPI 1275632895
  Care Compare affiliation
• NYU Langone Hospitals

  • Ambulance
  • Brooklyn, NY
  • NPI 1346614443

  Hospital

  Care Compare affiliation
• NYU Langone Hospitals

  dba NYU Langone Hospital Long Island

  • General Acute Care Hospital
  • Mineola, NY
  • NPI 1427616002
  Care Compare affiliation
• NYU Langone Hospitals

  • Oncology Clinic/Center
  • New York, NY
  • NPI 1437230034

  Hospital

  Care Compare affiliation
• NYU Langone Hospitals

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1619341716
  Care Compare affiliation
• NYU Langone Hospitals

  • General Acute Care Hospital
  • New York, NY
  • NPI 1669578324
  Care Compare affiliation
• NYU Langone Hospitals

  • General Acute Care Hospital
  • New York, NY
  • NPI 1801992631
  Care Compare affiliation
• NYU Langone Hospitals

  dba NYU Langone Hospital - Suffolk

  • General Acute Care Hospital
  • Patchogue, NY
  • NPI 1831910355
  Care Compare affiliation

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1063499267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 BANNOCK ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802044597",
            "telephone_number": "303-643-6494",
            "fax_number": "303-602-4168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 BANNOCK ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802044597",
            "telephone_number": "303-643-6494",
            "fax_number": "303-602-4168"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "David Grant Medical Center",
            "address_2": "101 Bodin Circle",
            "address_purpose": "LOCATION",
            "city": "Travis AFB",
            "state": "CA",
            "postal_code": "945351809",
            "country_code": "US",
            "telephone_number": "707-423-3040",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Kaiser Permanente",
            "address_2": "4601 Dale Rd.",
            "address_purpose": "LOCATION",
            "city": "Modesto",
            "state": "CA",
            "postal_code": "95356",
            "country_code": "US",
            "telephone_number": "209-735-3290",
            "fax_number": "877-516-6086",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "University of California San Francisco",
            "address_2": "505 Parnassus Ave.",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "94143",
            "country_code": "US",
            "telephone_number": "415-885-7268",
            "fax_number": "415-885-7445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "GRAHAM",
        "middle_name": "WILSON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01051128A",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01051128A",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "C142217",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CO",
            "license": "DR.0068264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4601 Dale Rd",
            "city": "Modesto",
            "state": "CA",
            "country_code": "US",
            "postal_code": "953569718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Colleen Marie Walla, REGISTERED NURSE
• Andrew Wallace, M.D.
• Ann Shirley Wallace
• Brandy Dawn Wallace
• Gerald F Wallace, DDS
• Jessica Danielle Wallace, MD
• Julie Gilman Wallace, P.T.
• Karrina Wallace, ND
• Madison Wallace
• Nicole Marie Wallace, PH.D.

• Diagnostic Radiology Physician in Denver, CO
• Providers in Denver, CO by specialty
• Diagnostic Radiology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; 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.