Active NPI
Augie Wallace
- Home Health Aide
- Upper Darby, PA
National Provider Identifier
1083083455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- License
- 28613601
- Practice address
- 8600 W Chester Pike Ste 308
Upper Darby, PA 19082-2629 - Phone
- (484) 433-8208
- NPI assigned
- Sep 16, 2015
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | 28613601 | PA | Primary |
Addresses
Primary practice location
8600 W Chester Pike Ste 308
Upper Darby, PA 19082-2629
Mailing address
4312 Main St Apt 316
Philadelphia, PA 19127-1531
Phone (484) 433-8208
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28613601 | PA | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631491200000",
"number": "1083083455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4312 MAIN ST APT 316",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191271531",
"telephone_number": "484-433-8208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8600 W CHESTER PIKE STE 308",
"city": "UPPER DARBY",
"state": "PA",
"postal_code": "190822629",
"telephone_number": "484-433-8208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "AUGIE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-09-16",
"last_updated": "2021-09-13",
"certification_date": "2021-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "PA",
"license": "28613601",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upper Darby, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.