Brendan Wallace, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

MD25666 Issued in ME

Practice address

55 Broadway
Bangor, ME 04401-5201

Phone

(207) 947-0469

NPI assigned

Aug 8, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

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

Merit-based Incentive Payment System (MIPS)

Final score

84.1 of 100Reported as group

Quality

64.8

Promoting interoperability

96

Improvement activities

40

Cost

68.87

Merit-based Incentive Payment System (MIPS)

Final score

89.98 of 100Reported as group

Quality

74.88

Promoting interoperability

96

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

90.63 of 100Reported as group

Quality

77.69

Promoting interoperability

95

Improvement activities

40

Cost

78.59

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St. Joseph Hospital

  • General Acute Care Hospital
  • Bangor, ME
  • NPI 1154321545

  Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1659916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1164159257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 FOUNTAIN ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013848",
            "telephone_number": "613-806-2243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 BROADWAY",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015201",
            "telephone_number": "207-947-0469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BRENDAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-08",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "ME",
            "license": "MD25666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Dawn Walker, LCSW
• Anakaye Walker, OT
• Candice G Walker, MS OTR/L
• Caroleann Mary Walker, LCSW
• Dale C Walker, MD
• Brian M Waller, DMD
• Dustin Waller, PHARMD
• Stephen M Walsh, MD
• William Michael Walsh Jr., LCPC-C
• David M Walter, M.D.

• Urology Physician in Bangor, ME
• Providers in Bangor, ME by specialty
• Urology Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; 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.