Stephen Russell Wallace, DO

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

2023-00659 Issued in NC

Practice address

2301 Erwin Rd
Durham, NC 27705-4699

Phone

(919) 684-8111

NPI assigned

Mar 24, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Diagnostic Radiology

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sharp Rees-Stealy Medical Group IncGroup PAC ID 8628972759, 872 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: swallace548119@direct.medicine.duke.edu

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.

• Sharp Rees-Stealy Medical Group, Inc

  • Internal Medicine Physician
  • San Diego, CA
  • NPI 1285616177
  Medicare reassignment Care Compare group NPD
• Duke University Health System Inc

  • Diagnostic Radiology Physician
  • Cary, NC
  • NPI 1780097618
  NPD
• Sharp Rees-Stealy Medical Group, Inc

  • Optometrist
  • San Diego, CA
  • NPI 1063172351
  NPD
• Sharp Rees-Stealy Medical Center

  • Physical Therapist
  • Chula Vista, CA
  • NPI 1407096589
  NPD (past)

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

{
    "created_epoch": "1521849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1194220061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 63362",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282633362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054699",
            "telephone_number": "919-684-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "STEPHEN",
        "middle_name": "RUSSELL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-24",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2023-00659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla J Wallace
• Lauren Rose Wallace, MSW, LCSWA
• Roberta Wallace
• Scott Arthur Wallace, PA-C
• Shelvey Jean Wallace, LCSW
• Todd A Wallace, PA-C
• Stacey Greanias Wallen, CGC
• Ethan Waller, RD, LDN
• Jesscia Wallis
• Walltown Community Outreach, Inc.

• Diagnostic Radiology Physician in Durham, NC
• Providers in Durham, NC by specialty
• Diagnostic Radiology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.