Susan L. Wallace, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

G42602 Issued in CA

Practice address

13652 Cantara St
Panorama City, CA 91402-5423

Phone

(818) 375-2000

NPI assigned

Nov 13, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Psychiatry

Education

New York Medical College, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clinica Sierra VistaGroup PAC ID 3870407505, shared by 31 NPIs, 180 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: swallace125584@direct.renown.org
• Direct secure messaging: swallace21134@clinicasierravista.direct-ci.com

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.

• Barton Healthcare System

  • Internal Medicine Physician
  • South Lake Tahoe, CA
  • NPI 1235196015
  Medicare reassignment NPD
• Camarena Health

  • Federally Qualified Health Center (FQHC)
  • Madera, CA
  • NPI 1891778114
  Medicare reassignment NPD
• Clinica Sierra Vista

  • Federally Qualified Health Center (FQHC)
  • Fresno, CA
  • NPI 1740439314
  Medicare reassignment NPD
• Clinica Sierra Vista

  • Federally Qualified Health Center (FQHC)
  • Bakersfield, CA
  • NPI 1861494338
  Medicare reassignment NPD
• Tahoe Carson Valley Medical Group Inc

  • Family Medicine Physician
  • South Lake Tahoe, CA
  • NPI 1508865528

  Psychiatry

  Medicare reassignment NPD
• Camarena Health

  • Federally Qualified Health Center (FQHC)
  • Coarsegold, CA
  • NPI 1023513538
  NPD
• Camarena Health

  • Federally Qualified Health Center (FQHC)
  • Los Banos, CA
  • NPI 1114757754
  NPD
• Clinica Sierra Vista

  • Community/Retail Pharmacy
  • Lamont, CA
  • NPI 1275161325
  NPD
• Clinica Sierra Vista

  • Federally Qualified Health Center (FQHC)
  • Delano, CA
  • NPI 1316949837
  NPD
• Clinica Sierra Vista

  • Federally Qualified Health Center (FQHC)
  • Fresno, CA
  • NPI 1669621447
  NPD
• Barton Healthcare System

  • Diagnostic Radiology Physician
  • Stateline, NV
  • NPI 1467046102
  NPD

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586390400000",
    "number": "1255402160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13652 CANTARA ST",
            "city": "PANORAMA CITY",
            "state": "CA",
            "postal_code": "914025423",
            "telephone_number": "818-375-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13652 CANTARA ST",
            "city": "PANORAMA CITY",
            "state": "CA",
            "postal_code": "914025423",
            "telephone_number": "818-375-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3810 Rosin Ct Ste 100",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958341657",
            "country_code": "US",
            "telephone_number": "530-749-3242",
            "fax_number": "530-749-3248",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1275 Tharp Rd",
            "address_purpose": "LOCATION",
            "city": "Yuba City",
            "state": "CA",
            "postal_code": "959932645",
            "country_code": "US",
            "telephone_number": "530-749-3242",
            "fax_number": "530-749-3248",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5730 Packard Ave Ste 500",
            "address_purpose": "LOCATION",
            "city": "Marysville",
            "state": "CA",
            "postal_code": "959017119",
            "country_code": "US",
            "telephone_number": "530-749-3242",
            "fax_number": "530-749-3248",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SUSAN",
        "middle_name": "L.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G42602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shilpa R. Wali, MD
• Loretta Walker
• Todd Walker
• John K. Wall, MD
• Debra R Wallace, NP
• Walmart Inc.
• Walmart Inc.
• Walmart, Inc.
• Robert Francis Walsh, M.P.T.
• Esther Chuan Wah Wang-O'Connell, MD

• Psychiatry Physician in Panorama City, CA
• Providers in Panorama City, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2020; 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.