Wallace B Mendelson, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

C35090 Issued in CA

Practice address

1 E. Apache St.
Remuda Ranch
Wickenburg, AZ 85390

Phone

(831) 287-0518

NPI assigned

Mar 20, 2009

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

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 17, 2017 through May 17, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• County of San Benito Behavioral Health

  • Case Management Agency
  • Hollister, CA
  • NPI 1790525871
  NPD (past)

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

{
    "created_epoch": "1237507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320278400000",
    "number": "1063653061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10869 N SCOTTSDALE RD",
            "address_2": "#103-317",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852545280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 E. APACHE ST.",
            "address_2": "REMUDA RANCH",
            "city": "WICKENBURG",
            "state": "AZ",
            "postal_code": "85390",
            "telephone_number": "831-287-0518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDELSON",
        "first_name": "WALLACE",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-03-20",
        "last_updated": "2011-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "C35090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jan Malacara, PA-C
• Amy Christine Manuele, LCSW
• Frank Harrison Mazziotti Sr., DC
• Barbara Davis McArthur, MC
• Bradley J Meek, DO
• Mgo Orthopelvic Physical Therapy
• Miller Clinic LTD
• Vance B. Miller, M.D.
• Rachel Childers Minton
• Clay Mitchell, PTA

• Psychiatry Physician in Wickenburg, AZ
• Providers in Wickenburg, AZ by specialty
• Psychiatry Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; 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.

Verify at the official NPI Registry.