Todd A Wallace, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

102437 Issued in NC

Practice address

3643 N Roxboro St
Durham, NC 27704-2702

Phone

(919) 470-4000

Fax

(919) 470-7392

NPI assigned

Jun 26, 2006

Sex

Male

Sole proprietor

No

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

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carolina Quickcare Family Practice, PLLCGroup PAC ID 0840682340, 107 clinicians

Duke Health Integrated Practice IncGroup PAC ID 8325412737, 3,140 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Duke Regional Hospital Hospital, Durham, NC, CCN 340155

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: twallace219045@direct.medicine.duke.edu

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.

• Duke Health Integrated Practice, Inc.

  • General Practice Physician
  • Durham, NC
  • NPI 1205553369
  Medicare reassignment Care Compare group NPD
• Carolina Quickcare Family Practice, PLLC

  • Internal Medicine Physician
  • Biscoe, NC
  • NPI 1881360899
  Medicare reassignment Care Compare group
• Vidant Medical Group LLC

  • Multi-Specialty Clinic/Center
  • Greenville, NC
  • NPI 1477648731
  Medicare reassignment NPD
• Fastmed P.C.

  • Family Medicine Physician
  • Durham, NC
  • NPI 1629841788
  Medicare reassignment
• Duke Health Integrated Practice, Inc

  • Gastroenterology Physician
  • Raleigh, NC
  • NPI 1780374884
  NPD
• Vidant Medical Group LLC

  • Ambulatory Surgical Clinic/Center
  • Kinston, NC
  • NPI 1376049619
  NPD
• Emergency Medicine Physicians of Pasquotank County, PLLC

  • Emergency Medicine Physician
  • Elizabeth City, NC
  • NPI 1205875267
  NPD (past)
• Fastmed Primary Care, P.C.

  • Family Medicine Physician
  • Fayetteville, NC
  • NPI 1912774423
  NPD (past)
• United Emergency Services, Inc.

  • Emergency Medicine Physician
  • Booneville, MS
  • NPI 1326007915

  Physician Assistant

  NPD (past)

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

• Duke University Health System Inc

  • Clinical Medical Laboratory
  • Durham, NC
  • NPI 1689656480

  Hospital

  Care Compare affiliation
• Duke University Health System, Inc.

  • General Acute Care Hospital
  • Durham, NC
  • NPI 1871592113
  Care Compare affiliation

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455667200000",
    "number": "1073540209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 GRAVEL BROOK CT",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275196009",
            "telephone_number": "262-883-4133",
            "fax_number": "919-267-4710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3643 N ROXBORO ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277042702",
            "telephone_number": "919-470-4000",
            "fax_number": "919-470-7392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TODD",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2016-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "102437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Rose Wallace, MSW, LCSWA
• Roberta Wallace
• Scott Arthur Wallace, PA-C
• Shelvey Jean Wallace, LCSW
• Stephen Russell Wallace, DO
• Stacey Greanias Wallen, CGC
• Ethan Waller, RD, LDN
• Jesscia Wallis
• Walltown Community Outreach, Inc.
• David Walmer

• Physician Assistant in Durham, NC
• Providers in Durham, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2016; 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.