William Dean Wallace, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

A77909 Issued in CA

Practice address

1500 San Pablo St
Los Angeles, CA 90033-5313

Phone

(323) 442-2582

NPI assigned

Jul 3, 2006

Last updated

Nov 27, 2023By 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 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Pathology

Education

Rush Medical College of Rush University, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Usc Care Medical Group IncGroup PAC ID 0446157747, 1,378 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Keck Hospital of Usc Hospital, Los Angeles, CA, CCN 050696
• Usc Kenneth Norris Jr Cancer Hospital Hospital, Los Angeles, CA, CCN 050660

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: william.wallace@direct.usc.edu

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.

• Usc Care Medical Group, Inc

  • General Practice Physician
  • Los Angeles, CA
  • NPI 1902846306

  Anatomic Pathology & Clinical Pathology

  Medicare reassignment Care Compare group NPD
• Usc Care Medical Group, Inc

  dba Fair Oaks Clinic

  • Durable Medical Equipment & Medical Supplies
  • Pasadena, CA
  • NPI 1427937390
  NPD
• Consultants for Path & Lab Med Inc, a Medical Group

  • Specialist
  • West Hollywood, CA
  • NPI 1588691414
  NPD (past)
• CPLM Pathology Outreach Services

  • Anatomic Pathology & Clinical Pathology Physician
  • Los Angeles, CA
  • NPI 1235460890
  NPD (past)
• Keck Medical Center of Usc

  dba USC Kenneth Norris Jr. Hospital

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1417554528
  NPD (past)
• Regents Univ of Calif Los Angeles

  dba Resnick Neuropsychiatric Hospital at UCLA

  • Psychiatric Hospital
  • Los Angeles, CA
  • NPI 1952308363
  NPD (past)
• Usc University Hospital, Inc.

  dba USC Hospital

  • Psychiatric Hospital Unit
  • Los Angeles, CA
  • NPI 1790718500
  NPD (past)
• Usc Verdugo Hills Hospital, LLC

  dba Verdugo Hills Hospital

  • General Acute Care Hospital
  • Glendale, CA
  • NPI 1265875207
  NPD (past)

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

• Keck Medical Center of Usc

  dba Keck Hospital of USC

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1013514199
  Care Compare affiliation
• Keck Medical Center of Usc

  dba USC Kenneth Norris Jr. Hospital

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1417554528
  Care Compare affiliation

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1245269943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-442-2582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SAN PABLO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335313",
            "telephone_number": "323-442-2582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "WILLIAM",
        "middle_name": "DEAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "A77909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "william.wallace@direct.usc.edu",
            "affiliation": "Y",
            "affiliationName": "USC CARE MEDICAL GROUP, INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1500 San Pablo St",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900335313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Patricia Wallace, PSYD, LMFT
• Rayvohn Wallace
• Ryan Christopher Wallace, D.D.S.
• Shunte Wallace
• Torrionda Wallace, B.S.
• Zemeris E Wallace
• Suzanne Marie Wallach, LMFT
• Agnes Soriano Wallbom, M.D., M.S.
• Drew Alan Walleck, ESQ.
• Donald E. Wallens, M.D.

• Anatomic Pathology & Clinical Pathology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Anatomic Pathology & Clinical Pathology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.