Jeffrey Wallace, MD

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

27855 Issued in CO

Practice address

12605 E 16TH Ave
Aurora, CO 80045-2545

Phone

(720) 848-0000

NPI assigned

Oct 13, 2006

Last updated

May 8, 2025By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

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

Geriatric Medicine

Education

University of Michigan Medical School, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

San Luis Valley Community Mental Health Center, Inc.Group PAC ID 0345267779, 34 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• San Luis Valley Community Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Alamosa, CO
  • NPI 1467289280
  Medicare reassignment Care Compare group NPD
• San Luis Valley Community Mental Health Center

  dba San Luis Valley Behavioral Health Group

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Monte Vista, CO
  • NPI 1861018558
  NPD
• San Luis Valley Community Mental Health Center, Inc.

  dba San Luis Valley Behavioral Health Group

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Alamosa, CO
  • NPI 1891522645
  NPD
• San Luis Valley Community Mental Health Center, Inc.

  dba San Luis Valley Behavioral Health Group

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Center, CO
  • NPI 1326865320
  NPD (past)

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746662400000",
    "number": "1215027990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 876",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800400876",
            "telephone_number": "303-493-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12605 E 16TH AVE",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800452545",
            "telephone_number": "720-848-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JEFFREY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "CO",
            "license": "0027855",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CO",
            "license": "27855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "37850539",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mikayla P Walla
• Allen Wallace
• Carmelle Wallace, MD
• Christine McKenney Wallace, OTR
• Elizabeth Brezinski Wallace, MD
• Kayla Wallace
• Meghan Wallace, DO
• Nichole G Wallace, MD
• Rachel Wallace
• Rachel Schwartz Wallach, PA-C

• Geriatric Medicine (Internal Medicine) Physician in Aurora, CO
• Providers in Aurora, CO by specialty
• Geriatric Medicine (Internal Medicine) Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2025; 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.