NPIMap

Individual provider Active NPI

Lincoln R Wallace, MD

  • Family Medicine Physician
  • Fort Dodge, IA
National Provider Identifier
1184696437
Registry record updated Dec 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34646 Issued in IA
Practice address
800 Kenyon Rd
Fort Dodge, IA 50501-5776
Phone
(515) 574-6800
NPI assigned
Feb 2, 2006
Last updated
Dec 22, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34646 IA Primary

Addresses

Primary practice location

800 Kenyon Rd
Fort Dodge, IA 50501-5776

Mailing address

24 N 9TH St
Suite a
Fort Dodge, IA 50501-3909
Phone (515) 574-6890

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100225000090 IA Practitioner - Family Practice 0143131714 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Trinity Regional Medical CenterGroup PAC ID 7315858529, 170 clinicians

Practice addresses (Care Compare)

800 Kenyon Rd
Fort Dodge, IA 50501-5776

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.76 of 100Reported as individual
Quality
95.92
Promoting interoperability
90
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Friendship Haven, Inc PastSince Dec 12, 2005 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: lwallace3120@direct.unitypoint.org

Ownership & related parties

All facility ownership & control disclosures 16

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Trinity Regional Medical CenterFort Dodge, IA, CCN 160016 Hospital Corporate Officer
Corporate Director		 Jan 1, 2018
Jan 1, 2015
Friendship HavenFort Dodge, IA, CCN 165291 Skilled nursing facility Adp of the SNF Aug 14, 2025
Fort Dodge Health and RehabilitationFort Dodge, IA, CCN 165156 Skilled nursing facility Operational/Managerial Control
Managing Control - Governing Body
Adp of the SNF		 Jul 5, 2024
Jul 5, 2024
Jul 5, 2024
Unitypoint Clinic Family Medicine Second Avenue NorthFort Dodge, IA, CCN 168599 Rural health clinic Corporate Officer
Corporate Director		 Jan 1, 2018
Jan 1, 2015
Unitypoint Clinic Family Medicine Sac CitySac City, IA, CCN 168600 Rural health clinic Corporate Officer
Corporate Director		 Jan 1, 2018
Jan 1, 2015
Unitypoint Clinic - Kenyon RoadFort Dodge, IA, CCN 168604 Rural health clinic Contracted Managing Employee
Corporate Officer
Corporate Director
Operational/Managerial Control		 Dec 24, 2017
Jan 1, 2018
Jan 1, 2015
Dec 24, 2017
Unitypoint Clinic Family Medicine MansonManson, IA, CCN 168606 Rural health clinic Corporate Officer
Corporate Director		 Jan 1, 2018
Jan 1, 2015
Unitypoint Clinic Family Medicine PocahontasPocahontas, IA, CCN 168598 Rural health clinic Corporate Officer
Corporate Director		 Jan 1, 2018
Jan 1, 2015
Unitypoint Clinic Family Medicine HumboldtHumboldt, IA, CCN 168597 Rural health clinic Corporate Officer
Corporate Director		 Jan 1, 2018
Jan 1, 2015
Unitypoint Clinic Family Medicine Lake ViewLake View, IA, CCN 168605 Rural health clinic Corporate Officer
Corporate Director		 Jan 1, 2018
Jan 1, 2015
Unitypoint Clinic Family Medicine LaurensLaurens, IA, CCN 168596 Rural health clinic Corporate Officer
Corporate Director		 Jan 1, 2018
Jan 1, 2015
Unitypoint Clinic Family Medicine Eagle GroveEagle Grove, IA, CCN 168601 Rural health clinic Corporate Officer
Corporate Director		 Jan 1, 2018
Jan 1, 2015
Unitypoint Clinic Pediatrics Fort DodgeFort Dodge, IA, CCN 168603 Rural health clinic Corporate Officer
Corporate Director		 Jan 1, 2018
Jan 1, 2015
Unitypoint Clinic Family Health Center - Storm LakeStorm Lake, IA, CCN 168613 Rural health clinic Corporate Officer
Corporate Director		 Jan 1, 2018
Jan 1, 2018
Unitypoint Clinic Family Medicine - Buena VistaStorm Lake, IA, CCN 168612 Rural health clinic Corporate Officer
Corporate Director		 Jan 1, 2018
Jan 1, 2015
Unitypoint Clinic - Express in Fort DodgeFort Dodge, IA, CCN 168658 Rural health clinic Corporate Officer
Corporate Director		 Jan 1, 2018
Jan 1, 2015

Owned or controlled facilities with NPI records 16

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 16

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482364800000",
    "number": "1184696437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 N 9TH ST",
            "address_2": "SUITE A",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505013909",
            "telephone_number": "515-574-6890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 KENYON RD",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505015776",
            "telephone_number": "515-574-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LINCOLN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-02",
        "last_updated": "2016-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "34646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Dodge, IA

Sources for this page

Verify at the official NPI Registry.