NPIMap

Individual provider Active NPI

Elron J Wallace, MD

  • Anesthesiology Physician
  • Glen Burnie, MD
National Provider Identifier
1124122809
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
D65067 Issued in MD
Practice address
301 Hospital Dr
Glen Burnie, MD 21061-5803
Phone
(410) 787-4656
NPI assigned
Sep 12, 2006
Last updated
Jan 9, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD428013 PA
Anesthesiology Physician 207L00000X D65067 MD Primary

Addresses

Primary practice location

301 Hospital Dr
Glen Burnie, MD 21061-5803

Mailing address

255 W Michigan Ave
Jackson, MI 49201-2218
Phone (517) 787-6440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC, PA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20070219000222 MD Practitioner - Anesthesiology 3577665769 Reassigns benefits to 3 organizations
I20200116001756 DC Practitioner - Anesthesiology 3577665769 Reassigns benefits to 2 organizations
I20220210000407 PA Practitioner - Anesthesiology 3577665769 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Guthrie Medical Group PCGroup PAC ID 6002728656, 795 clinicians
North American Partners in Anesthesia Maryland LLCGroup PAC ID 1850283144, 47 clinicians
North American Partners in Anesthesia, Pennsylvania , LLCGroup PAC ID 7517960834, 302 clinicians

Practice addresses (Care Compare)

1 Guthrie Dr
Corning, NY 14830-3696
Phone (607) 973-7200

1 Guthrie SQ
Sayre, PA 18840-1625
Phone (570) 887-3192

106 Bow St Christianacare Union Hospi
Elkton, MD 21921-5596
Phone (410) 398-4000

111 S Front St
Harrisburg, PA 17101-2010
Phone (717) 782-3131

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D65067MDMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North American Partners in Anesthesia Maryland LLC Anesthesiology CurrentSince Nov 20, 2019 Accepting new patients
Excela Health Physician Practices, Inc. CurrentSince Jul 1, 2024 Accepting new patients
Guthrie Medical Group, P.C. Anesthesiology CurrentSince Jan 17, 2022 Accepting new patients
Guthrie Medical Group, P.C. Anesthesiology CurrentSince Jan 17, 2022 Accepting new patients
North American Partners in Anesthesia, Pennsylvania , LLC Anesthesiology CurrentSince Dec 6, 2023 Accepting new patients
Excela Health Physician Practices, Inc. CurrentSince Jul 1, 2024 Accepting new patients
First Colonies Anesthesia Associates, LLC Anesthesiology CurrentSince Jun 1, 2015 Accepting new patients
Excela Health Physician Practices, Inc Current Accepting new patients
Anesthesia Company, LLC Anesthesiology CurrentSince Jun 1, 2024 Accepting new patients
Guthrie Medical Group, P.C. Current Accepting new patients

Locations

2001 Medical Pkwy
Annapolis, MD 21401
Phone (410) 280-5601

6430 Rockledge Dr
Ste 160
Bethesda, MD 20817
Phone (301) 312-6144

106 Bow St
Elkton, MD 21921
Phone (410) 298-2000

301 Hospital Dr
Glen Burnie, MD 21061
Phone (410) 787-4565

70 Sherry Ln
Ste 101
Prnc Frederck, MD 20678
Phone (410) 889-2040

5401 Old Court Rd
Randallstown, MD 21133
Phone (301) 337-2727

8905 Fairview Rd
Silver Spring, MD 20910
Phone (888) 554-0631

8322 Bellona Ave
Ste 201
Towson, MD 21204
Phone (410) 337-2688

255 W Michigan Ave
Jackson, MI 49201

1 Guthrie Dr
Corning, NY 14830
Phone (607) 937-7130

206 E Brown St
East Stroudsburg, PA 18301
Phone (570) 420-4951

532 W Pittsburgh St
Greensburg, PA 15601
Phone (724) 832-4000

111 S Front St
Harrisburg, PA 17101
Phone (717) 782-3282

4300 Londonderry Rd
Lower Paxton, PA 17109
Phone (717) 597-7044

8835 Germantown Ave
Philadelphia, PA 19118
Phone (215) 248-8227

1 Guthrie Sq
Sayre, PA 18840
Phone (570) 887-3106

Interoperability endpoints

  • Direct secure messaging: ewallace171625@direct-guthrie.org

Organizations & group practices 10

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 8

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": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704758400000",
    "number": "1124122809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W MICHIGAN AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012218",
            "telephone_number": "517-787-6440",
            "fax_number": "517-787-4146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 HOSPITAL DR",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615803",
            "telephone_number": "410-787-4656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ELRON",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-12",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "MD428013",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MD",
            "license": "D65067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

Verify at the official NPI Registry.