Keri Ann Wallace, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

046025 Issued in CT

Practice address

282 Washington St
CCMC, Primary Care Center, 1F
Hartford, CT 06106-3322

Phone

(860) 545-9333

Fax

(860) 545-9301

NPI assigned

Jan 30, 2006

Last updated

Apr 12, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Keri Ann Lindell Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kwallace2387@connecticutchildrens.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Connecticut Children's Specialty Group, Inc.

  • Pediatrics Physician
  • Hartford, CT
  • NPI 1669448882
  Medicare reassignment NPD
• Connecticut Children's Specialty Group, Inc.

  • Ophthalmology Physician
  • Glastonbury, CT
  • NPI 1568056984

  Pediatrics

  NPD

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1205807179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "282 WASHINGTON ST",
            "address_2": "CCMC, PRIMARY CARE CENTER, 1F",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061063322",
            "telephone_number": "860-545-9333",
            "fax_number": "860-545-9301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "282 WASHINGTON ST",
            "address_2": "CCMC, PRIMARY CARE CENTER, 1F",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061063322",
            "telephone_number": "860-545-9333",
            "fax_number": "860-545-9301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KERI",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-30",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "046025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwallace2387@connecticutchildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "282 Washington St",
            "address_2": "CCMC, Primary Care Center, 1F",
            "city": "Hartford",
            "state": "CT",
            "country_code": "US",
            "postal_code": "061063322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KERI",
            "last_name": "LINDELL",
            "middle_name": "ANN",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Suzanne Walker, PA
• Tomisha Yvon Walker, LCSW
• Watney W Walker
• Karen Lynn Wall, APRN
• Cara Wallace, PSYD
• Randall Kent Wallace, PSY.D.
• Diamond M Wallen, LMSW
• Walnut Dental
• Walnut Dental, Inc
• Lisa Walsh-Makas, MS, CCC-SLP

• Pediatrics Physician in Hartford, CT
• Providers in Hartford, CT by specialty
• Pediatrics Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.