John George Wallace Jr., M.D.

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

G45690 Issued in CA

Practice address

4101 Torrance Blvd
Em Dept
Torrance, CA 90503-4607

Phone

(310) 540-7676

Fax

(405) 751-3183

NPI assigned

Jun 19, 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 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Emergency Medicine

Education

Medical College of Pennsylvania, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Specialist Physicians Medical Associates, IncGroup PAC ID 2163329822, 41 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Little Company of Mary Med Ctr Torrance Hospital, Torrance, CA, CCN 050353

Merit-based Incentive Payment System (MIPS)

Final score

91.46 of 100Reported as group

Quality

78.18

Improvement activities

40

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.

• Emergency Specialist Physicians Medical Associates, Inc

  • Emergency Medicine Physician
  • Torrance, CA
  • NPI 1518917913
  Medicare reassignment Care Compare group NPD

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

• Providence Health System Southern California

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1902844988
  Care Compare affiliation

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348012800000",
    "number": "1164467320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 W MEMORIAL RD",
            "address_2": "SUITE 121",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341785",
            "telephone_number": "405-751-4664",
            "fax_number": "405-751-3183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 TORRANCE BLVD",
            "address_2": "EM DEPT",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905034607",
            "telephone_number": "310-540-7676",
            "fax_number": "405-751-3183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JOHN",
        "middle_name": "GEORGE",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-19",
        "last_updated": "2012-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "CA",
            "license": "G45690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G456900",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Legacy Pillar Walker
• Sheryl Walker
• Kyle Thomas Walkwitz
• Rebecca Marie Wall, OTD, OTR/L
• Damaya Lashawn Wallace
• Marilyn Wallace, LMFT
• Qyana Anyese Wallace, A.S.W.
• William Wallace
• Josh O Wallsh, M.D.
• Walmart Inc.

• Emergency Medical Services (Emergency Medicine) Physician in Torrance, CA
• Providers in Torrance, CA by specialty
• Emergency Medical Services (Emergency Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; 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.