NPIMap

Individual provider Active NPI

Stephen Blake Wallace, MD

  • Orthopaedic Foot and Ankle Surgery Physician
  • Denver, CO
National Provider Identifier
1205222502
Registry record updated Jul 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Foot and Ankle Surgery PhysicianTaxonomy code 207XX0004X
License
DR.0063577 Issued in CO
Practice address
3055 Roslyn St Unit 200
Denver, CO 80238-3324
Phone
(303) 724-7378
NPI assigned
Apr 13, 2015
Last updated
Jul 29, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X DR.0063577 CO Primary

Addresses

Primary practice location

3055 Roslyn St Unit 200
Denver, CO 80238-3324

Mailing address

10361 E 28TH PL
Denver, CO 80238-3051
Phone (225) 572-6083

Other practice location 1

5323 Harry Hines Blvd
Dallas, TX 75390-7201
Phone (214) 648-0253

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20210504000184 TX Practitioner - Orthopedic Surgery 2365866282 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Baylor College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Green Oaks Physical Therapy Limited PartnershipGroup PAC ID 4688582141, shared by 2 NPIs, 208 clinicians
Texas Star Orthopedic Institute LLCGroup PAC ID 7618392424, 22 clinicians

Practice addresses (Care Compare)

2710 N Josey LN
Carrollton, TX 75007-5400
Phone (469) 701-9108

5228 W Plano Pkwy
Plano, TX 75093-5005
Phone (972) 250-5700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
23.34 of 100Reported as individual
Quality
21.98
Promoting interoperability
0
Improvement activities
30

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Removal of tissue1-10
Removal of nail tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Star Orthopedic Institute, LLC CurrentSince Apr 1, 2021 Accepting new patients

Locations

5228 W Plano Pkwy
Plano, TX 75093
Phone (972) 250-5655

Interoperability endpoints

  • Direct secure messaging: stephen.wallace.1@31411.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1428883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1205222502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10361 E 28TH PL",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802383051",
            "telephone_number": "225-572-6083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 ROSLYN ST UNIT 200",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802383324",
            "telephone_number": "303-724-7378"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5323 Harry Hines Blvd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "753907201",
            "country_code": "US",
            "telephone_number": "214-648-0253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "STEPHEN",
        "middle_name": "BLAKE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-13",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "CO",
            "license": "DR.0063577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.