Amanda Fraser Wallace, MD

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

0052096 Issued in CO

Practice address

755 Heritage Rd
Golden, CO 80401-3600

Phone

(303) 277-0700

NPI assigned

Jun 22, 2009

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 CO, IN2 enrollments

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 2

Specialty

Pain ManagementAlso: Anesthesiology

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Yampa Valley Medical CenterGroup PAC ID 5890685689, 128 clinicians

Select Physical Therapy of West Denver Limited PartnershipGroup PAC ID 6709771157, shared by 5 NPIs, 530 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uchealth Yampa Valley Medical Center Hospital, Steamboat Springs, CO, CCN 060049

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amanda.wallace.1@14209.direct.athenahealth.com

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.

• Yampa Valley Medical Center

  • General Acute Care Hospital
  • Steamboat Springs, CO
  • NPI 1790787307
  Medicare reassignment Care Compare group NPD
• Yampa Valley Medical Center

  • Multi-Specialty Clinic/Center
  • Steamboat Springs, CO
  • NPI 1295177426
  NPD
• Yampa Valley Medical Center

  • Pharmacy
  • Steamboat Springs, CO
  • NPI 1861814097
  NPD
• Indiana University Health Bloomington Inc

  • Psychiatry Physician
  • Bloomington, IN
  • NPI 1871519074
  NPD
• Indiana University Health Bloomington Inc

  • Community/Retail Pharmacy
  • Bloomington, IN
  • NPI 1922640077
  NPD
• Mednow Clinics, Inc

  • Interventional Pain Medicine Physician
  • Englewood, CO
  • NPI 1174272421
  NPD (past)
• Mednow Clinics, Inc

  • Primary Care Clinic/Center
  • Aurora, CO
  • NPI 1669888764
  NPD (past)

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

• Yampa Valley Medical Center

  • General Acute Care Hospital
  • Oak Creek, CO
  • NPI 1164081345
  Care Compare affiliation
• Yampa Valley Medical Center

  • General Acute Care Hospital
  • Hayden, CO
  • NPI 1295394203
  Care Compare affiliation
• Yampa Valley Medical Center

  • General Acute Care Hospital
  • Steamboat Springs, CO
  • NPI 1790787307
  Care Compare affiliation

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

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546819200000",
    "number": "1174750707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1818 E 7TH AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802183645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 HERITAGE RD",
            "city": "GOLDEN",
            "state": "CO",
            "postal_code": "804013600",
            "telephone_number": "303-277-0700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "888 S Auto Mall Rd",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474015430",
            "country_code": "US",
            "telephone_number": "812-353-2700",
            "fax_number": "812-353-2701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "AMANDA",
        "middle_name": "FRASER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-22",
        "last_updated": "2019-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CO",
            "license": "DR0052096",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CO",
            "license": "0052096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co.
• Andrea Walker, M.A. CCC-SLP
• Katherine Walker, D.P.T
• Theresa Lynn Walker, RN,MSAC.
• Melody Leighton Walkup, DPT
• Laura Marie Walls, RD, PA-C
• James Walsh
• Nicholas E. Walsh, PA-C
• Scott Alan Walter, M.D.
• Krystyna Wamboldt, MA, JD, MFTC

• Pain Medicine (Anesthesiology) Physician in Golden, CO
• Providers in Golden, CO by specialty
• Pain Medicine (Anesthesiology) Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2019; 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.