NPIMap

Individual provider Active NPI

Wallace C Baker, M.D.

  • Family Medicine Physician
  • Idaho Falls, ID
National Provider Identifier
1083696967
Registry record updated Jul 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M2619 Issued in ID
Practice address
1880 John Adams Pkwy
Idaho Falls, ID 83401-4315
Phone
(208) 524-6633
Fax
(208) 524-9952
NPI assigned
Nov 16, 2005
Last updated
Jul 19, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 19, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M2619 ID Primary

Addresses

Primary practice location

1880 John Adams Pkwy
Idaho Falls, ID 83401-4315

Mailing address

1880 John Adams Pkwy
Idaho Falls, ID 83401-4315
Phone (208) 524-6633

Other identifiers 10

IdentifierTypeStateIssuer
000010027582OtherIDBLUE SHIELD GROUP
000010001770OtherIDBLUE SHIELD PROVIDER NUMB
266877OtherIDDMBA
8K123OtherIDBLUE CROSS GROUP
002796800MedicaidID
1134140148OtherIDBAKER FAMILY GROUP NPI
72132OtherIDIDAHO BLUE CROSS PROVIDER
807937700MedicaidID
DE1614OtherIDRR MEDICARE GRP
080097138OtherIDRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100823001005 ID Practitioner - Family Practice 6608824164 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Utah School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wallace C BakerGroup PAC ID 0446208904, 6 clinicians

Practice addresses (Care Compare)

1880 John Adams Pkwy
Idaho Falls, ID 83401-4315
Phone (208) 524-6633

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M2619IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wallace C Baker Family Medicine CurrentSince Aug 1, 1996 Accepting new patients
Wallace Bakers Mid-Level Group CurrentSince Aug 1, 1996 Accepting new patients
Gem Medical Investors, LLC Past Accepting new patients

Locations

1880 John Adams Pkwy
Idaho Falls, ID 83401
Phone (208) 524-6633

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IDIEAA/Endpoint/IDIEAA

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Life Care Center of Idaho FallsIdaho Falls, ID, CCN 135091 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 1, 2020
Mar 17, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279497600000",
    "number": "1083696967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1880 JOHN ADAMS PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014315",
            "telephone_number": "208-524-6633",
            "fax_number": "208-524-9952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1880 JOHN ADAMS PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014315",
            "telephone_number": "208-524-6633",
            "fax_number": "208-524-9952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "WALLACE",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-16",
        "last_updated": "2010-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M2619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP",
            "identifier": "000010027582",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER NUMB",
            "identifier": "000010001770",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "266877",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP",
            "identifier": "8K123",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002796800",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BAKER FAMILY GROUP NPI",
            "identifier": "1134140148",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO BLUE CROSS PROVIDER",
            "identifier": "72132",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807937700",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GRP",
            "identifier": "DE1614",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080097138",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.