Wallace Carroll Vaughan Jr., M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

13438 Issued in AL

Practice address

6980 Winton Blount Blvd
Montgomery, AL 36117-3556

Phone

(334) 277-0484

Fax

(334) 272-8877

NPI assigned

Oct 17, 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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Otolaryngology

Education

University Alabama Birmingham - School of Optometry, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Central Alabama ENT AssociatesGroup PAC ID 3870516180, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Medical Center East Hospital, Montgomery, AL, CCN 010149
• Baptist Medical Center South Hospital, Montgomery, AL, CCN 010023
• Prattville Baptist Hospital Hospital, Prattville, AL, CCN 010108

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• bcbs alabama network 01G0
• bcbs alabama network 01E0
• bcbs alabama network 01H0
• bcbs alabama network 01A0
• bcbs alabama network 01B0

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.

• Central Alabama ENT Associates

  • Otolaryngology Physician
  • Montgomery, AL
  • NPI 1124108535
  Medicare reassignment Care Compare group NPD Authorized official
• Central Alabama Audiology Center, LLC

  • Audiologist
  • Montgomery, AL
  • NPI 1649119595
  NPD (past)

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

• Health Care Authority for Baptist Health an Affiliate of Uabhs

  • General Acute Care Hospital
  • Montgomery, AL
  • NPI 1104917780
  Care Compare affiliation
• Health Care Authority for Baptist Health, an Affiliate of Uabhs

  • General Acute Care Hospital
  • Montgomery, AL
  • NPI 1700977105
  Care Compare affiliation
• The Health Care Authority for Baptist Health an Affiliate of Uabhs

  • General Acute Care Hospital
  • Prattville, AL
  • NPI 1942391230
  Care Compare affiliation

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447372800000",
    "number": "1104906510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6980 WINTON BLOUNT BLVD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173556",
            "telephone_number": "334-277-0484",
            "fax_number": "334-272-8877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6980 WINTON BLOUNT BLVD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173556",
            "telephone_number": "334-277-0484",
            "fax_number": "334-272-8877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHAN",
        "first_name": "WALLACE",
        "middle_name": "CARROLL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2015-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "AL",
            "license": "13438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528701330",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "17143",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCARE",
            "identifier": "040002702",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jaclyn Vance, LICSW
• Richard K. Vann, D.M.D.
• Jogy Varghese, M.D.
• Jonathan Mac Varner, M.D.
• Karen Vaughan
• Vaughn Family Care LLC
• Vaughn Podiatry Center PC
• Hadryan H Vaughn, D.P.M.
• Vaughserenity Transport
• Vaxinall LLC.

• Otolaryngology Physician in Montgomery, AL
• Providers in Montgomery, AL by specialty
• Otolaryngology Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2015; 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.