Shane K Wallace, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

3008218 Issued in KY

Practice address

911 Bypass Rd BLDG a
Pikeville, KY 41501-1689

Phone

(606) 430-3500

Fax

(606) 437-1033

NPI assigned

Feb 9, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA, KY, TN3 enrollments

Enrollment records 3

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pikeville Medical Center IncGroup PAC ID 6709790157, 427 clinicians

Medstream Anesthesia PLLCGroup PAC ID 7416198049, 571 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Clinch Valley Medical Center Hospital, Richlands, VA, CCN 490060
• Pikeville Medical Center Hospital, Pikeville, KY, CCN 180044

Merit-based Incentive Payment System (MIPS)

Final score

92.67 of 100Reported as group

Quality

81.47

Promoting interoperability

100

Improvement activities

40

Cost

81.83

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: swallace21726@pikevillekydirect.org

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.

• Pikeville Medical Center Inc.

  • Multi-Specialty Clinic/Center
  • Pikeville, KY
  • NPI 1528195864

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Medstream Anesthesia PLLC

  • Anesthesiology Physician
  • Richardson, TX
  • NPI 1649616160

  Nurse Anesthetist, Certified Registered, VA

  Medicare reassignment Care Compare group NPD
• American Anesthesiology of Tennessee, P.C.

  • Anesthesiology Physician
  • Knoxville, TN
  • NPI 1609822998
  Medicare reassignment NPD
• American Anesthesiology of Tennessee, P.C.

  • Certified Registered Nurse Anesthetist
  • Knoxville, TN
  • NPI 1245279777

  Nurse Anesthetist, Certified Registered

  NPD
• Pikeville Medical Center Inc

  • Multi-Specialty Clinic/Center
  • Cheyenne, WY
  • NPI 1891599502
  NPD
• Norton Community Physician Services LLC

  • Internal Medicine Physician
  • Pennington Gap, VA
  • NPI 1841098175
  NPD (past)
• Norton Community Physician Services LLC

  • Internal Medicine Physician
  • Norton, VA
  • NPI 1861674160
  NPD (past)
• Virginia Highlands Anesthesia, PC

  • Anesthesiology Physician
  • Abingdon, VA
  • NPI 1508830993
  NPD (past)

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

• Pikeville Medical Center Inc

  • General Acute Care Hospital
  • Pikeville, KY
  • NPI 1285621623
  Care Compare affiliation
• Clinch Valley Medical Center Inc.

  • General Acute Care Hospital
  • Richlands, VA
  • NPI 1871534297
  Care Compare affiliation

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

{
    "created_epoch": "1234137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1235378605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 432",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415020432",
            "telephone_number": "606-430-3500",
            "fax_number": "606-437-1033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 BYPASS RD BLDG A",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415011689",
            "telephone_number": "606-430-3500",
            "fax_number": "606-437-1033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SHANE",
        "middle_name": "K",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-09",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "VA",
            "license": "0001179608",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0024168171",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "33501",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3008218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235378605",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100075570",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "swallace21726@PIKEVILLEKYDIRECT.ORG",
            "affiliation": "N",
            "endpointDescription": "Direct address for ccds",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Standard direct functionality",
            "address_1": "911 Bypass Rd Bldg A",
            "city": "Pikeville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "415011689",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Wal-Mart Stores East, LP
• Walgreen Co
• Walgreen Co
• Hannah Grace Wallace
• Meredith L. Wallace, RD, LD
• Stephanie Lynn Wallace
• Zachary Thomas Walters, OD
• Elyn Harriet Wang, MD
• Weiping Wang, MD
• Ariel Ward, RBT

• Certified Registered Nurse Anesthetist in Pikeville, KY
• Providers in Pikeville, KY by specialty
• Certified Registered Nurse Anesthetist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.