Kellie L Wallace-Wilding, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

41583 Issued in TN

Practice address

2863 Highway 45 Byp
Jackson, TN 38305-3618

Phone

(731) 664-1375

Fax

(731) 664-1378

NPI assigned

Sep 14, 2006

Sex

Female

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 TN

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

Family Practice

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Jackson Clinic PAGroup PAC ID 2668376872, 171 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intrepid USA Healthcare Services Home health agency, Jackson, TN, CCN 447565
• Volunteer Home Care Home health agency, Humboldt, TN, CCN 447557
• Tennessee Quality Care - Home Health Home health agency, Parsons, TN, CCN 447402
• Amedisys Home Health Care Home health agency, Jackson, TN, CCN 447278
• Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kelliewallacewilding@jcpa.allscriptsdirect.net

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.

• Jackson Clinic PA

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1285629386

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Jackson Spa LLC

  • Massage Therapist
  • Jackson, TN
  • NPI 1932089091
  NPD Authorized official
• Jackson Clinic PA

  • Durable Medical Equipment & Medical Supplies
  • Jackson, TN
  • NPI 1689443038
  NPD
• Bolivar General Hospital, Inc.

  • General Acute Care Hospital
  • Bolivar, TN
  • NPI 1174545446
  NPD (past)
• Bolivar General Hospital, Inc.

  • Critical Access Hospital
  • Bolivar, TN
  • NPI 1518957950
  NPD (past)

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

• Centerwell Health Services USA, LLC

  • Home Health Agency
  • Jackson, TN
  • NPI 1699758722
  Care Compare affiliation
• HHC, LLC

  • Home Health Agency
  • Jackson, TN
  • NPI 1851349559
  Care Compare affiliation
• Jackson Madison County General Hospital

  • General Acute Care Hospital
  • Jackson, TN
  • NPI 1093705428
  Care Compare affiliation
• Tennessee Valley Home Care, LLC

  • Home Health Agency
  • Parsons, TN
  • NPI 1396702536
  Care Compare affiliation
• Volunteer Home Care, Inc.

  • Home Health Agency
  • Humboldt, TN
  • NPI 1659320190
  Care Compare affiliation

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354147200000",
    "number": "1063518629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 400",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383020400",
            "telephone_number": "731-423-8697",
            "fax_number": "731-422-5743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2863 HIGHWAY 45 BYP",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053618",
            "telephone_number": "731-664-1375",
            "fax_number": "731-664-1378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE-WILDING",
        "first_name": "KELLIE",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2012-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "41583",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3827516",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jayme Leke Walker, NP-C
• Marla Walker, DOCTOR OF PHARMACY
• Traci Walker, APRN
• Tracie A Walker, MD
• Tracy Walker
• Robert Wallace, CRNA
• Taurus Waller, MS
• Donna J Wallis, W.H.N.P.
• Morgan Walls, PHYSICAL THERAPY
• Rose Marie Walters, FNP

• Family Medicine Physician in Jackson, TN
• Providers in Jackson, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; 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.