Danielle Charisse Wallace, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME129213 Issued in FL

Practice address

1801 Lee Rd Ste 165
Winter Park, FL 32789

Phone

(407) 975-0410

Fax

(407) 975-0413

NPI assigned

Apr 26, 2007

Last updated

Jun 13, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI, FL, WA, NM, TX5 enrollments

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 5

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dwallace126969@mymichiganhealth.midirect.net
• Direct secure messaging: dwallace2344238@direct.trinity-health.org

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.

• Florida Hospital Medical Group Inc

  dba AdventHealth Medical Group

  • Family Medicine Physician
  • Orlando, FL
  • NPI 1225034234

  Pediatrics

  Medicare reassignment NPD
• Key West Hma Physician Management, LLC

  • Internal Medicine Physician
  • Cudjoe Key, FL
  • NPI 1871548651
  Medicare reassignment NPD
• Grant County Public Hospital District 1

  dba Samaritan Clinic

  • Rural Health Clinic/Center
  • Moses Lake, WA
  • NPI 1619086766
  Medicare reassignment NPD
• McLaren Thumb Region

  dba Huron Medical Center

  • General Acute Care Hospital
  • Bad Axe, MI
  • NPI 1245257880
  Medicare reassignment NPD
• Mymichigan Medical Center Alma

  • Emergency Medicine Physician
  • Alma, MI
  • NPI 1568914422
  Medicare reassignment NPD
• Mymichigan Medical Center Alpena

  • Emergency Medicine Physician
  • Alpena, MI
  • NPI 1508332792
  Medicare reassignment NPD
• Mymichigan Medical Center Gladwin

  • General Practice Physician
  • Gladwin, MI
  • NPI 1881869774
  Medicare reassignment NPD
• Pecos Valley of New Mexico, LLC

  • General Practice Physician
  • Carlsbad, NM
  • NPI 1972569820
  Medicare reassignment NPD
• Texas Tech University Health Sciences Center El Paso

  • Internal Medicine Physician
  • El Paso, TX
  • NPI 1598705055
  Medicare reassignment NPD
• Baby Blossom Pediatrcs

  • Pediatrics Physician
  • West Branch, MI
  • NPI 1306714118
  NPD Authorized official
• Florida Hospital Medical Group Inc

  dba Rothman Orthopaedics AdventHealth Medical Group at Minneola

  • Prosthetic/Orthotic Supplier
  • Minneola, FL
  • NPI 1285591545
  NPD
• Key West Hma Physician Management LLC

  • Orthopaedic Surgery Physician
  • Key West, FL
  • NPI 1346548229
  NPD

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1114147006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 LEE RD STE 165",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "32789",
            "telephone_number": "407-975-0410",
            "fax_number": "407-975-0413"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1627 S 3050 W",
            "address_purpose": "LOCATION",
            "city": "Vernal",
            "state": "UT",
            "postal_code": "840788719",
            "country_code": "US",
            "telephone_number": "616-717-3171",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4845 Alameda Ave",
            "address_purpose": "LOCATION",
            "city": "El Paso",
            "state": "TX",
            "postal_code": "799052705",
            "country_code": "US",
            "telephone_number": "915-215-5700",
            "fax_number": "915-215-8872",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DANIELLE",
        "middle_name": "CHARISSE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-26",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD61340360",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME129213",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "8023169-1205",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301088447",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "U0741",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2231891",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Walker, MSW
• Erica J Walker, O.D.
• Kelly Anne Walker, MS, LMHC
• La Tanya D Walker
• Macy Walker
• Matthew Wallace, PSY.D.
• David Regis Walsh, LMHC
• Walter a Conlan III MD PA (Florida Wound Care Doctors)
• Linda H. Walters, D.M.D.
• Brenda Walton-Scott

• Pediatrics Physician in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.