Active NPI
Arlie N. Wallace, D.O.
- Psychiatry Physician
- Sarasota, FL
National Provider Identifier
1063559417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- OS-0004791
- Practice address
- 3300 S Tamiami TRL
Suite 5
Sarasota, FL 34239-5100 - Phone
- (941) 366-0664
- NPI assigned
- Feb 1, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | OS-0004791 | FL | Primary |
Addresses
Primary practice location
3300 S Tamiami TRL
Suite 5
Sarasota, FL 34239-5100
Mailing address
3300 S Tamiami TRL
Suite 5
Sarasota, FL 34239-5100
Phone (941) 366-0664
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2014 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS-0004791 | FL | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063559417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3300 S TAMIAMI TRL",
"address_2": "SUITE 5",
"city": "SARASOTA",
"state": "FL",
"postal_code": "342395100",
"telephone_number": "941-366-0664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3300 S TAMIAMI TRL",
"address_2": "SUITE 5",
"city": "SARASOTA",
"state": "FL",
"postal_code": "342395100",
"telephone_number": "941-366-0664"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "ARLIE",
"middle_name": "N.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "FL",
"license": "OS-0004791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sarasota, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.