NPIMap

Individual provider Active NPI

Jamie Marie Wallace, P.A.

  • Surgical Physician Assistant
  • Alexandria, LA
National Provider Identifier
1255523346
Registry record updated Aug 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
TEMP PERMIT Issued in LA
Practice address
3311 Prescott Rd
Suite 201
Alexandria, LA 71301-3900
Phone
(318) 442-6767
Fax
(318) 441-1259
NPI assigned
Aug 13, 2007
Last updated
Aug 13, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X TEMP PERMIT LA Primary

Addresses

Primary practice location

3311 Prescott Rd
Suite 201
Alexandria, LA 71301-3900

Mailing address

3311 Prescott Rd
Suite 201
Alexandria, LA 71301-3900
Phone (318) 442-6767

Other identifiers 1

IdentifierTypeStateIssuer
APPLIED FORMedicaidLA

Other names 1

  • Jamie Marie Hollis Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071002000853 LA Practitioner - Physician Assistant 7214022466 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cenla Urology Clinic LLCGroup PAC ID 0840385241, 6 clinicians
Mid Louisiana Surgical SpecialistsGroup PAC ID 4284610080, 9 clinicians

Practice addresses (Care Compare)

3311 Prescott Rd
Alexandria, LA 71301-3917
Phone (318) 442-3384

3311 Prescott Rd
Suite 201
Alexandria, LA 71301-3983
Phone (318) 442-6767

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Health Central Louisiana CurrentSince Jun 1, 2016 Accepting new patients
Radiology Associates of Southwest Louisiana Past Accepting new patients

Locations

3330 Masonic Dr
Alexandria, LA 71301
Phone (318) 448-6917

Organizations & group practices 5

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.

Hospital & facility affiliations 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186963200000",
    "number": "1255523346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3311 PRESCOTT RD",
            "address_2": "SUITE 201",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713013900",
            "telephone_number": "318-442-6767",
            "fax_number": "318-441-1259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3311 PRESCOTT RD",
            "address_2": "SUITE 201",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713013900",
            "telephone_number": "318-442-6767",
            "fax_number": "318-441-1259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JAMIE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-13",
        "last_updated": "2007-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "LA",
            "license": "TEMP PERMIT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "APPLIED FOR",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAMIE",
            "last_name": "HOLLIS",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Alexandria, LA

Sources for this page

Verify at the official NPI Registry.