Wallace Clements Tarry, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

200200613 Issued in NC

Practice address

146 Medical Park Rd
Ste 206
Mooresville, NC 28117-8528

Phone

(704) 799-3939

NPI assigned

Mar 9, 2006

Sex

Male

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 2

Medicare fee-for-service enrollment

Enrolled in NC, GA2 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

Vascular SurgeryAlso: Thoracic Surgery

Education

Duke University School of Medicine, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Carolinas Physicians Network IncGroup PAC ID 3375449655, 2,324 clinicians

Health Services of Central GeorgiaGroup PAC ID 9638076730, 300 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carolinas Medical Center-Northeast Hospital, Concord, NC, CCN 340001
• Duke Health Lake Norman Hospital Hospital, Mooresville, NC, CCN 340129
• Atrium Health University City Hospital, Charlotte, NC, CCN 340166
• Atrium Health Navicent the Medical Center Hospital, Macon, GA, CCN 110107

Merit-based Incentive Payment System (MIPS)

Final score

94 of 100Reported as apm

Quality

81.63

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wtarry464245@carolinashealthcaresystem.direct-ci.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.

• Carolinas Physicians Network Inc

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Charlotte, NC
  • NPI 1477878890
  Medicare reassignment Care Compare group NPD
• Health Services of Central Georgia, Inc

  • Multi-Specialty Clinic/Center
  • Macon, GA
  • NPI 1184679482

  Surgery

  Medicare reassignment Care Compare group NPD
• Carolinas Physicians Network Inc

  • Endocrinology, Diabetes & Metabolism Physician
  • Charlotte, NC
  • NPI 1437038544
  NPD
• Carolinas Physicians Network Inc.

  • Vascular Surgery Physician
  • Charlotte, NC
  • NPI 1881624807
  NPD
• Carolinas Physicians Network, Inc

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1578939914
  NPD (past)

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

• Duke Health Lake Norman Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Mooresville, NC
  • NPI 1114731064
  Care Compare affiliation
• The Charlotte-Mecklenburg Hospital Authority

  • General Acute Care Hospital
  • Charlotte, NC
  • NPI 1346297892
  Care Compare affiliation
• The Charlotte-Mecklenburg Hospital Authority

  • General Acute Care Hospital
  • Concord, NC
  • NPI 1487866315
  Care Compare affiliation
• The Charlotte-Mecklenburg Hospital Authority

  • Psychiatric Hospital Unit
  • Concord, NC
  • NPI 1629283866
  Care Compare affiliation
• The Medical Center of Central Georgia Inc

  • General Acute Care Hospital
  • Macon, GA
  • NPI 1043270564
  Care Compare affiliation

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1205804945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 MEDICAL PARK RD",
            "address_2": "STE 206",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178528",
            "telephone_number": "704-799-3939"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1237 Harding Pl",
            "address_2": "Ste 3100",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "28204",
            "country_code": "US",
            "telephone_number": "704-373-0212",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "134 Medical Park Rd",
            "address_2": "Ste 111 - Adult Cardiology",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "281178526",
            "country_code": "US",
            "telephone_number": "704-801-9100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 E W T Harris Blvd",
            "address_2": "Ste 1213",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282623485",
            "country_code": "US",
            "telephone_number": "704-863-1950",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "447 McAlister Rd",
            "address_2": "STE 3200",
            "address_purpose": "LOCATION",
            "city": "Lincolnton",
            "state": "NC",
            "postal_code": "280924114",
            "country_code": "US",
            "telephone_number": "980-212-6300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TARRY",
        "first_name": "WALLACE",
        "middle_name": "CLEMENTS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "200200613",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NC",
            "license": "200200613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wtarry464245@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "146 Medical Park Rd",
            "address_2": "Ste 206",
            "city": "Mooresville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281178528",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Daveisha Mercedes Tanck, LCSWA
• Erin Tankoos, FNP
• Patricia Tanksley, CNM
• Tarr Optometric, PLLC
• Alanna Tarrao, LCMHC-A, LCAS-A, NCC
• Amanda Maire Tase, MS-OTR-L
• Taylor Rehab Inc
• Amy Taylor-Smith, LCMHCA
• Janet Taylor, PT
• Laparis Taylor

• Vascular Surgery Physician in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Vascular Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; 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.