NPIMap

Individual provider Active NPI

Douglas Walled, M.D.

  • Diagnostic Radiology Physician
  • Albany, NY
National Provider Identifier
1235377334
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
265496 Issued in NY
Practice address
315 So Manning Blvd
SPH Medical Imaging
Albany, NY 12208
Phone
(518) 525-1550
NPI assigned
Jan 27, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 265496 NY Primary
Diagnostic Radiology Physician 2085R0202X 049745 CT

Addresses

Primary practice location

315 So Manning Blvd
SPH Medical Imaging
Albany, NY 12208

Mailing address

PO Box 14890
Albany, NY 12212-4890

Other practice location 1

1 Edgewater St
6th floor Suite 3 attn Teresa Lomangino
Staten Island, NY 10305-4907
Phone (718) 947-7000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130325000554 NY Practitioner - Diagnostic Radiology 5092992891 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Yale University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ellis HospitalGroup PAC ID 5890607410, 250 clinicians

Practice addresses (Care Compare)

1101 Nott St
Schenecctady, NY 12308-2425
Phone (518) 243-4000

315 S Manning Blvd
Albany, NY 12208-1707
Phone (518) 525-1852

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
049745CTMDDiagnostic Radiology Physician
265496NYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Albany Advanced Imaging PLLC Diagnostic Radiology CurrentSince May 4, 2015 Accepting new patients
Northeast Medical Imaging PC Diagnostic Radiology CurrentSince May 4, 2015 Accepting new patients
Albany Advanced Imaging PLLC Diagnostic Radiology CurrentSince May 4, 2015 Accepting new patients
Ellis Hospital CurrentSince Sep 29, 2023 Accepting new patients
St. Peter's Health Partners Medical Associates, P.C. Diagnostic Radiology CurrentSince Mar 1, 2015 Accepting new patients

Locations

315 S Manning Blvd
Albany, NY 12208
Phone (518) 525-1852

3 Atrium Dr
Ste 160
Albany, NY 12205
Phone (518) 438-0600

425 New Scotland Ave
Albany, NY 12208
Phone (518) 525-6987

3 Atrium Dr
Albany, NY 12205
Phone (518) 435-1234

1101 Nott St
Schenectady, NY 12308
Phone (518) 243-1916

2 New Hampshire Ave
Troy, NY 12180
Phone (518) 272-0331

Interoperability endpoints

  • Direct secure messaging: dwalled788735@direct.trinity-health.org

Organizations & group practices 5

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1233014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622073600000",
    "number": "1235377334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14890",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122124890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 SO MANNING BLVD",
            "address_2": "SPH MEDICAL IMAGING",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "12208",
            "telephone_number": "518-525-1550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Edgewater St",
            "address_2": "6th floor Suite 3 attn Teresa Lomangino",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103054907",
            "country_code": "US",
            "telephone_number": "718-947-7000",
            "fax_number": "718-947-7005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLED",
        "first_name": "DOUGLAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-27",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "265496",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CT",
            "license": "049745",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "315 So Manning Blvd",
            "address_2": "SPH Medical Imaging",
            "city": "Albany",
            "state": "NY",
            "country_code": "US",
            "postal_code": "12208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.