Active NPI
Austin William Wallace
- Orthopaedic Trauma Physician
- Savannah, GA
National Provider Identifier
1063901023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Trauma Physician
- License
- 101390
- Practice address
- 210 E Derenne Ave
Savannah, GA 31405-6736 - Phone
- (912) 644-5300
- NPI assigned
- May 5, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | ME163050 | FL | |
| Orthopaedic Trauma Physician | 207XX0801X | ME163050 | FL | |
| Orthopaedic Trauma Physician | 207XX0801X | 101390 | GA | Primary |
Addresses
Primary practice location
210 E Derenne Ave
Savannah, GA 31405-6736
Mailing address
210 E Derenne Ave
Savannah, GA 31405-6736
Other practice location 1
3450 Hull Rd
Gainesville, FL 32607-4144
Phone (352) 273-7001
Other practice location 2
1600 SW Archer Rd
Gainesville, FL 32610-4144
Phone (352) 273-7002
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Orthopedic Surgery
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
210 E Derenne Ave
Savannah, GA 31405-0000
Phone (912) 644-5300
Hospital & facility affiliations
- Amedisys Home Health of Bluffton
- Savannah Health Services LLC Dba Memorial Health University Medical Center
- St Joseph'S Hospital - Savannah
- Coastal Carolina Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 47.54 of 100
- Quality
- 38.49
- Promoting interoperability
- 0
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 15 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optim Orthopedics Trauma, LLC | Orthopaedic Surgery | Current | Accepting new patients |
Locations
210 E Derenne Ave
Savannah, GA 31405
Phone (912) 355-0140
Interoperability endpoints
- austin.wallace.1@16403.direct.athenahealth.com
- awallace628995@direct.shands.ufl.edu
Organizations & group practices 1
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.
-
- Orthopaedic Trauma Physician
- Savannah, GA
- NPI 1770318180
Orthopaedic Surgery
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Savannah, GA
- NPI 1063406684
-
- General Acute Care Hospital
- Savannah, GA
- NPI 1053824292
-
- Home Health Agency
- Bluffton, SC
- NPI 1215110226
-
- General Acute Care Hospital
- Hardeeville, SC
- NPI 1205605409
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739145600000",
"number": "1063901023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 E DERENNE AVE",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314056736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 E DERENNE AVE",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314056736",
"telephone_number": "912-644-5300"
}
],
"practiceLocations": [
{
"address_1": "3450 Hull Rd",
"address_purpose": "LOCATION",
"city": "Gainesville",
"state": "FL",
"postal_code": "326074144",
"country_code": "US",
"telephone_number": "352-273-7001",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1600 SW Archer Rd",
"address_purpose": "LOCATION",
"city": "Gainesville",
"state": "FL",
"postal_code": "326104144",
"country_code": "US",
"telephone_number": "352-273-7002",
"fax_number": "352-273-7388",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALLACE",
"first_name": "AUSTIN",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-05",
"last_updated": "2025-02-10",
"certification_date": "2025-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "FL",
"license": "ME163050",
"primary": false
},
{
"code": "207XX0801X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Orthopaedic Trauma",
"state": "FL",
"license": "ME163050",
"primary": false
},
{
"code": "207XX0801X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Orthopaedic Trauma",
"state": "GA",
"license": "101390",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Savannah, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; 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.