Sonny S Wallace, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

112565 Issued in NE

Practice address

7500 Mercy Rd
Omaha, NE 68124-2319

Phone

(855) 524-4001

Fax

(402) 398-5589

NPI assigned

Jul 20, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NE, IA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

University of Nebraska College of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Iowa Physicians Clinic Medical FoundationGroup PAC ID 8729992318, 1,254 clinicians

Alegent Creighton ClinicGroup PAC ID 1951210418, shared by 2 NPIs, 951 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• CHI Health Midlands Hospital, Papillion, NE, CCN 280105

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Iowa Physicians Clinic Medical Foundation

  • General Practice Physician
  • West Des Moines, IA
  • NPI 1366425274

  NE

  Medicare reassignment Care Compare group
• CHI Health Clinic Specialty, LLC

  • Hospitalist Physician
  • Lincoln, NE
  • NPI 1285138065
  Medicare reassignment NPD
• Alegent Creighton Clinic

  • Family Medicine Physician
  • Omaha, NE
  • NPI 1548287907
  Medicare reassignment
• Alegent Creighton Clinic

  • Family Medicine Physician
  • Council Bluffs, IA
  • NPI 1598811069
  Medicare reassignment
• The Finley Hospital

  • Emergency Medicine Physician
  • Dubuque, IA
  • NPI 1134176308

  NE

  Medicare reassignment
• Alegent Creighton Clinic

  • Internal Medicine Physician
  • Omaha, NE
  • NPI 1518227859
  NPD
• Alegent Creighton Health

  • General Acute Care Hospital
  • Papillion, NE
  • NPI 1215006101
  NPD (past)

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

• Alegent Creighton Health

  • General Acute Care Hospital
  • Papillion, NE
  • NPI 1215006101
  Care Compare affiliation

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

{
    "created_epoch": "1532044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537401600000",
    "number": "1164909339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7500 MERCY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242319",
            "telephone_number": "855-524-4001",
            "fax_number": "402-398-5589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7500 MERCY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242319",
            "telephone_number": "855-524-4001",
            "fax_number": "402-398-5589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SONNY",
        "middle_name": "S",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-20",
        "last_updated": "2018-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": "H152173",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NE",
            "license": "112565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Wallace
• Matthew Edwin Wallace, ATC, PES
• Nancy Wallace
• Sade Marie Wallace
• Shelley Lynn Wallace
• Susan H Wallace, APRN
• Tiffany Wallace, CNA, CMA, MS
• Zarria Wallace
• Joy J Wallar, MHP
• Ashley Brooke Wallen, PA-C

• Nurse Practitioner in Omaha, NE
• Providers in Omaha, NE by specialty
• Nurse Practitioner in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; 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.