Individual provider Active NPI

Molly Wallace

  • Physician Assistant
  • Columbus, OH
National Provider Identifier
1174488423
Registry record updated Feb 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.010011RX Issued in OH
Practice address
3525 Olentangy River Rd
Columbus, OH 43214-3937
Phone
(614) 566-1997
NPI assigned
Dec 18, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 50.010011RX OH Primary

Addresses

Primary practice location

3525 Olentangy River Rd
Columbus, OH 43214-3937

Mailing address

1482 Aschinger Blvd
Columbus, OH 43212-2690

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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 1

Enrollment IDStateProvider typePAC IDDetails
I20260311000257 OH Practitioner - Physician Assistant 1153804810 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid-Ohio Emergency Services, LLCGroup PAC ID 8921907601, 84 clinicians

Practice addresses (Care Compare)

3535 Olentangy River Rd
Columbus, OH 43214-3908
Phone (614) 566-1997

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
50.010011RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Ohio Emergency Services, LLC Physician Assistant CurrentSince Apr 1, 2026 Accepting new patients

Locations

3535 Olentangy River Rd
Columbus, OH 43214
Phone (614) 566-1997

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1766016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772064000000",
    "number": "1174488423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1482 ASCHINGER BLVD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432122690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3525 OLENTANGY RIVER RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432143937",
            "telephone_number": "614-566-1997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MOLLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-12-18",
        "last_updated": "2026-02-26",
        "certification_date": "2026-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.010011RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.