Candace Nicole Wallis

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

15085 Issued in FL

Practice address

125 Central Ave Ste 290
Coos Bay, OR 97420-2342

Phone

(541) 267-2113

NPI assigned

Oct 24, 2021

Last updated

Oct 24, 2021By 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

• Candace Nicole Rieger Former name

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Coastal Center, LLC.Group PAC ID 8426046707, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Coastal Center, LLC.

  • Mental Health Counselor
  • Coos Bay, OR
  • NPI 1538278536
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1635033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635033600000",
    "number": "1215691597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 WOODLAND DR",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202044",
            "telephone_number": "727-692-7373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 CENTRAL AVE STE 290",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202342",
            "telephone_number": "541-267-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "CANDACE",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-24",
        "last_updated": "2021-10-24",
        "certification_date": "2021-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "15085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CANDACE",
            "last_name": "RIEGER",
            "middle_name": "NICOLE",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Wal-Mart Stores Inc (Wal-Mart Pharmacy 10-2301)
• Krystal Cathleen Walden
• Bryan Charles Walker, RPH
• Michaela Walker, DDS
• Robert E Wallace
• Walmart Inc. (Walmart Pharmacy 10-1880)
• Walmart, Inc. (Walmart pharmacy 10-3164)
• Tasha Anne Walter, CADC 1, CRM, PSS
• Ronni Waltz, PSS
• Shawntae Marie Wardell

• Clinical Social Worker in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2021; 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.