Eric D Wallisa, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01054688A Issued in IN

Practice address

5955 S Emerson Ave
100
Indianapolis, IN 46237-2525

Phone

(317) 789-9600

Fax

(317) 789-0600

NPI assigned

Mar 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Emergency Physicians of Indianapolis, PC

  • Emergency Medicine Physician
  • Indianapolis, IN
  • NPI 1770538340
  NPD (past)
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1255309720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5955 S EMERSON AVE",
            "address_2": "100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462372525",
            "telephone_number": "317-789-9600",
            "fax_number": "317-789-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5955 S EMERSON AVE",
            "address_2": "100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462372525",
            "telephone_number": "317-789-9600",
            "fax_number": "317-789-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLISA",
        "first_name": "ERIC",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-10",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01054688A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "01054688A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE CSR",
            "identifier": "01054688B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura M Waller
• Barbara J Walling, FNP
• Guy R Walling, NP NURSE PRACTITIONE
• Martina Lynn Walling, PHARMD
• Radhika V Walling, M.D.
• Johanna Henderson Wallisa, MD
• Brooke Felicia Walls, MD
• Caren Walls, ATC
• Deborah Renee Walls, SOCIAL WORKER - CLIN
• Jenna Elise Walls, M.D.

• Family Medicine Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.