Darcie L Wallace, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

118539 Issued in MO

Practice address

615 S New Ballas Rd
Saint Louis, MO 63141-8221

Phone

(314) 251-6000

NPI assigned

Jul 10, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Mercy Clinic Cardiovascular and Thoracic Surgery, LLC

  • Vascular Surgery Physician
  • Washington, MO
  • NPI 1528192416
  NPD (past)
• St. Louis Heart Institute Cardiothoracic Surgeons, Inc.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Saint Peters, MO
  • NPI 1013935816
  NPD (past)
• Cardiothoracic Surgery Associates, P.C.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Swansea, IL
  • NPI 1073548608
  NPD (past)

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413936000000",
    "number": "1083648489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 180575",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631503511",
            "telephone_number": "314-251-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S NEW BALLAS RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418221",
            "telephone_number": "314-251-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DARCIE",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2014-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MO",
            "license": "118539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA CERT #",
            "identifier": "1016860",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashleigh Wallace, PHARMD
• Cassandra Marie Wallace, PNP
• Cherry Wallace, FNP
• Claire Wallace, PH.D.
• Colleen Maire Wallace, MD
• Erin Wallace
• Francene Wallace
• Gretchen Coleman Wallace, MS, RD, LD, CD
• Jacob Henry Wallace, MD
• James Wallace, MA, THM, STM

• Surgical Physician Assistant in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Surgical Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.