Individual provider Active NPI

Angela Darlene Wallace, M.D.

  • Anesthesiology Physician
  • Waco, TX
National Provider Identifier
1255510848
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
M7736 Issued in TX
Practice address
100 Hillcrest Medical Blvd
Waco, TX 76712-8897
Phone
(254) 202-5631
NPI assigned
Oct 31, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X M7736 TX Primary

Addresses

Primary practice location

100 Hillcrest Medical Blvd
Waco, TX 76712-8897

Mailing address

806 Tangle Way CT
Cedar Hill, TX 75104-7818
Phone (412) 216-0743

Other practice location 1

36000 Darnall Loop
Fort Hood, TX 76544-5095
Phone (254) 288-8197

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address awallace70644@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20080201000422 TX Practitioner - Anesthesiology 3476635186 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Saint Louis University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scott and White ClinicGroup PAC ID 8123923604, 2,426 clinicians

Practice addresses (Care Compare)

100 Hillcrest Med Blvde
Waco, TX 76712-8897
Phone (254) 202-5800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M7736TXMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Nov 1, 2009 Accepting new patients
Scott & White Clinic Anesthesiology Current Accepting new patients
Palo Pinto County Hospital District Current Accepting new patients
Palo Pinto County Hospital District Anesthesiology CurrentSince Oct 13, 2014 Accepting new patients
Palo Pinto County Hospital District CurrentSince Oct 13, 2014 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Anesthesiology CurrentSince Nov 1, 2009 Accepting new patients
Scott and White Clinic Anesthesiology CurrentSince Mar 23, 2015 Accepting new patients
Scott & White Clinic Anesthesiology CurrentSince Mar 23, 2015 Accepting new patients
Scott & White Hospital - Taylor Past Accepting new patients
Dallas Anesthesiology Associates, PA Anesthesiology Past Accepting new patients

Locations

101 Lafferty Ave
Cameron, TX 76520
Phone (254) 605-1100

5201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 590-1396

3500 Gaston Ave
Dallas, TX 75246

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

900 8th Ave
Ft Worth, TX 76104
Phone (817) 336-2100

602 Indiana Ave
Lubbock, TX 79415
Phone (806) 743-2898

400 SW 25th Ave
Mineral Wells, TX 76067
Phone (940) 325-7891

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

50 Hillcrest Medical Blvd
Ste 201
Waco, TX 76712
Phone (254) 202-0550

100 Hillcrest Medical Blvd
Waco, TX 76712
Phone (254) 202-2000

Interoperability endpoints

  • Direct secure messaging: awallace70644@direct.sw.org

Organizations & group practices 10

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1255510848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 TANGLE WAY CT",
            "city": "CEDAR HILL",
            "state": "TX",
            "postal_code": "751047818",
            "telephone_number": "412-216-0743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HILLCREST MEDICAL BLVD",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767128897",
            "telephone_number": "254-202-5631"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "36000 Darnall Loop",
            "address_purpose": "LOCATION",
            "city": "Fort Hood",
            "state": "TX",
            "postal_code": "765445095",
            "country_code": "US",
            "telephone_number": "254-288-8197",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ANGELA",
        "middle_name": "DARLENE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-31",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TX",
            "license": "M7736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awallace70644@direct.sw.org",
            "affiliation": "N",
            "address_1": "100 Hillcrest Medical Blvd",
            "city": "Waco",
            "state": "TX",
            "country_code": "US",
            "postal_code": "767128897",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.