Edward Alton Wallace, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

13597 Issued in SC

Practice address

300 Singleton Ridge Rd
Conway, SC 29526-9142

Phone

(843) 669-5162

Fax

(843) 669-5162

NPI assigned

Jan 25, 2007

Last updated

Dec 21, 2016By 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

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in SC

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

Anesthesiology

Education

Medical University of South Carolina College of Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

McLeod Physician Associates IIGroup PAC ID 8224031307, 541 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• McLeod Regional Medical Center-Pee Dee Hospital, Florence, SC, CCN 420051

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• McLeod Physician Associates II

  • Family Medicine Physician
  • Florence, SC
  • NPI 1801990494

  Anesthesiology

  Medicare reassignment Care Compare group NPD
• Coastal Healthcare Resources Inc

  • Anesthesiology Physician
  • Florence, SC
  • NPI 1467635128
  Medicare reassignment NPD
• Florence Surgery & Laser Center LLC

  • Ophthalmologic Surgery Clinic/Center
  • Florence, SC
  • NPI 1912959560
  Medicare reassignment NPD
• McLeod Physician Associates II

  dba McLeod Orthopaedics - Florence

  • Orthopaedic Surgery Physician
  • Florence, SC
  • NPI 1922555739
  NPD
• Advanced Pain Therapies, LLC

  • Specialist
  • Hartsville, SC
  • NPI 1154539278
  NPD (past)
• Anesthesiology Consultants of Florence

  • Anesthesiology Physician
  • Florence, SC
  • NPI 1437182474
  NPD (past)
• Conway Anesthesia Associates

  • Anesthesiology Physician
  • Conway, SC
  • NPI 1922028851
  NPD (past)
• Hartsville Anesthesia Associates

  • Specialist
  • Hartsville, SC
  • NPI 1871701029
  NPD (past)
• Sand Hills Anesthesia LLC

  • Anesthesiology Physician
  • Hartsville, SC
  • NPI 1548240724
  NPD (past)
• Anesthesia Network Services, LLC

  • Anesthesiology Physician
  • Ocala, FL
  • NPI 1508199142
  NPD (past)

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

• McLeod Regional Medical Center of the Pee Dee, Inc.

  • General Acute Care Hospital
  • Florence, SC
  • NPI 1699756221
  Care Compare affiliation

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482278400000",
    "number": "1255486452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SPRING FOREST RD",
            "address_2": "SUITE 130",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276162880",
            "telephone_number": "919-882-0705",
            "fax_number": "919-873-9821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE RD",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269142",
            "telephone_number": "843-669-5162",
            "fax_number": "843-669-5162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "EDWARD",
        "middle_name": "ALTON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2016-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "SC",
            "license": "13597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900433",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135972",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STANDARD TAX ID",
            "identifier": "570835798",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "E0051",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chyna Walker
• Jamison Kirk Walker
• Nicole Walker, BT
• Sherri Lynn Walker, MA, LPC
• Veronica Yolanda Walker
• Walmart Pharmacy
• Florian Aidan Walter, DO
• Jamie Warbutton
• Mary Ward, MS, LPC
• Warren D. Gibson (Waccamaw Prosthetics and Orthotics)

• Anesthesiology Physician in Conway, SC
• Providers in Conway, SC by specialty
• Anesthesiology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2016; 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.