Blake Taylor Wallace, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

POD-001117 Issued in AZ

Practice address

15601 N 28TH Ave Ste 102
Phoenix, AZ 85053-4061

Phone

(480) 844-8218

NPI assigned

Nov 14, 2020

Last updated

Jul 29, 2024By the provider in NPPES

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

Enrolled in AZ

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

California School of Podiatric Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Desert Foot and Ankle P CGroup PAC ID 3678461985, 6 clinicians

PNC Podiatry of Arizona PCGroup PAC ID 5496264863, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner Thunderbird Medical Center Hospital, Glendale, AZ, CCN 030089
• Abrazo Arrowhead Hospital Hospital, Glendale, AZ, CCN 030094
• Banner Estrella Medical Center Hospital, Phoenix, AZ, CCN 030115

Merit-based Incentive Payment System (MIPS)

Final score

85.37 of 100Reported as group

Quality

75.04

Promoting interoperability

97

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: blake.wallace.1@26083.direct.athenahealth.com
• Direct secure messaging: bwallace592342@direct.franciscanalliance.org
• FHIR API: https://api.platform.athenahealth.com/26083/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Desert Foot & Ankle P C

  • Podiatrist
  • Mesa, AZ
  • NPI 1639398183

  Foot & Ankle Surgery

  Medicare reassignment Care Compare group NPD
• PNC Podiatry of Arizona PC

  dba Desert Foot & Ankle

  • Foot & Ankle Surgery Podiatrist
  • Mesa, AZ
  • NPI 1063168359
  Medicare reassignment Care Compare group NPD
• Desert Foot & Ankle P C

  • Foot & Ankle Surgery Podiatrist
  • Glendale, AZ
  • NPI 1629962808
  NPD

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

• Banner Estrella Medical Center

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1275566200
  Care Compare affiliation
• Banner Thunderbird Medical Center

  • General Acute Care Hospital
  • Glendale, AZ
  • NPI 1154355188
  Care Compare affiliation
• VHS of Arrowhead, Inc

  dba Abrazo Arrowhead Campus

  • General Acute Care Hospital
  • Glendale, AZ
  • NPI 1326022765
  Care Compare affiliation
• VHS of Arrowhead, Inc.

  dba Abrazo Peoria Emergency Center

  • General Acute Care Hospital
  • Peoria, AZ
  • NPI 1801340781
  Care Compare affiliation

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

{
    "created_epoch": "1605312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1083216949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32611",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049150219",
            "telephone_number": "480-844-8218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15601 N 28TH AVE STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850534061",
            "telephone_number": "480-844-8218"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3100 Telegraph Ave",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946093239",
            "country_code": "US",
            "telephone_number": "800-607-6377",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8414 Naab Rd Ste 215",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462601972",
            "country_code": "US",
            "telephone_number": "317-338-7510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BLAKE",
        "middle_name": "TAYLOR",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-14",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "AZ",
            "license": "POD-001117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sterling Wall, DDS
• Tracy Wall
• Victoria M Wall
• Wallace Andrews LLC (Wallace Andrews)
• Annisha Wallace, LCSW
• Cheryl Wallace, RDH
• Christopher Scott Wallace, LCSW
• David Warner Wallace, MD
• Donna C Wallace, PNP
• Evelyn J Wallace, RN

• Foot & Ankle Surgery Podiatrist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Foot & Ankle Surgery Podiatrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; 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.