Wallace Glenn Jamison, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

4301508760 Issued in MI

Practice address

3285 122ND Ave
Allegan, MI 49010-9511

Phone

(269) 673-6617

NPI assigned

Jul 31, 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

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Specialty

Psychiatry

Education

Harvard Medical School, 1970

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679443200000",
    "number": "1215943279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 NORTHWEST BLVD",
            "city": "NASHUA",
            "state": "NH",
            "postal_code": "030634068",
            "telephone_number": "603-577-5721",
            "fax_number": "603-577-5713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3285 122ND AVE",
            "city": "ALLEGAN",
            "state": "MI",
            "postal_code": "490109511",
            "telephone_number": "269-673-6617"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4 Partridge Ln",
            "address_purpose": "LOCATION",
            "city": "East Kingston",
            "state": "NH",
            "postal_code": "038272052",
            "country_code": "US",
            "telephone_number": "603-347-1760",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAMISON",
        "first_name": "WALLACE",
        "middle_name": "GLENN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "234609",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301508760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "168245EU",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "P010234609",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "168245EU",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "P010234609",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02643823",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ROCHESTER BLUE SHIELD",
            "identifier": "P020234609",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "RA6483",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Irish, LLMSW
• Michael Jacoby, MD
• Syed Saeed Jafri, MD
• Raymond Jaglowski, M.D.
• Jamor James, ACTT THERAPIST
• Julia Ann Jenkins, REGISTERED DIETITIAN
• Amber Rae Johnson
• Carin Lea Johnson
• Cindy Johnston, LBSW
• Oliver Lawernce Johnston, MD

• Psychiatry Physician in Allegan, MI
• Providers in Allegan, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 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.
• 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.