Kelley Annette Wallace, DO

Primary specialty

Hospitalist PhysicianTaxonomy code 208M00000X

License

2012-00585 Issued in NC

Practice address

1750 Kernersville Medical Pkwy
Kernersville, NC 27284-7146

Phone

(336) 564-4866

Fax

(336) 277-6815

NPI assigned

Jul 16, 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

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

HospitalistAlso: Internal Medicine

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kwallace116151@direct.novanthealth.org

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.

• Novant Health Medical Group, LLC

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment Care Compare group NPD
• Forsyth Memorial Hospital, Inc.

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1104548874
  Medicare reassignment NPD
• Novant Health Thomasville Medical Center, LLC

  • Specialist
  • Thomasville, NC
  • NPI 1033160205
  Medicare reassignment NPD
• The Presbyterian Hospital

  • Geriatric Medicine (Internal Medicine) Physician
  • Charlotte, NC
  • NPI 1053365817
  Medicare reassignment NPD
• Wake Forest Health Network LLC

  • Pediatrics Physician
  • Greensboro, NC
  • NPI 1477785756
  Medicare reassignment NPD
• Cornerstone Health Care LLC

  • Surgery Physician
  • High Point, NC
  • NPI 1194167999
  NPD
• Forsyth Memorial Hospital Inc

  • Hematology & Oncology Physician
  • Thomasville, NC
  • NPI 1013226307
  NPD
• Forsyth Memorial Hospital, Inc.

  • Cardiovascular Disease Physician
  • Winston Salem, NC
  • NPI 1932935475
  NPD
• Novant Health Medical Group, LLC

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Novant Health Thomasville Medical Center LLC

  • Hematology & Oncology Physician
  • Winston Salem, NC
  • NPI 1649159609
  NPD
• Novant Medical Group, Inc.

  • Family Medicine Physician
  • Rolesville, NC
  • NPI 1235393802
  NPD
• The Presbyterian Hospital

  • Specialist
  • Huntersville, NC
  • NPI 1083927438
  NPD

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

• Forsyth Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1447200233
  Care Compare affiliation

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

{
    "created_epoch": "1247702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684800000000",
    "number": "1174753727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "336-564-4866",
            "fax_number": "336-277-6815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 KERNERSVILLE MEDICAL PKWY",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847146",
            "telephone_number": "336-564-4866",
            "fax_number": "336-277-6815"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1701 Westchester Drive",
            "address_2": "Suite 850",
            "address_purpose": "LOCATION",
            "city": "High Point",
            "state": "NC",
            "postal_code": "272627254",
            "country_code": "US",
            "telephone_number": "336-802-2145",
            "fax_number": "336-802-2693",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KELLEY",
        "middle_name": "ANNETTE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-16",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "DO.1175",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NC",
            "license": "2012-00585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwallace116151@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1701 Westchester Drive",
            "address_2": "Suite 850",
            "city": "High Point",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272627254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kevin Bradford Walker, PA-C
• Veronica Siafacas Walker, D.D.S.
• Zachary Walker, DDS
• Amy Jo Wallace, MD
• Diamond Wallace
• Thomas Raymond Walsh, MD
• Martha Walters, LPN
• Qianyun Wang, MD
• Kimberly Carroll Ward
• Kimberly Dawn Ward, FNP-C

• Hospitalist Physician in Kernersville, NC
• Providers in Kernersville, NC by specialty
• Hospitalist Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; 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.