Mary Jean Wall, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

35059303W Issued in OH

Practice address

1001 Lakeside Ave E Ste 1200
Cleveland, OH 44114-1172

Phone

(216) 362-2000

NPI assigned

Feb 9, 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

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in OH

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

Diagnostic Radiology

Education

Hahnemann Medical College and Hospital - Kansas City - NLG, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Columbus Radiology CorpGroup PAC ID 6507754983, 290 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy St Vincent Medical Center Hospital, Toledo, OH, CCN 360112
• Mercy Health - Defiance Hospital Hospital, Defiance, OH, CCN 360270
• Mercy Health - Tiffin Hospital Hospital, Tiffin, OH, CCN 360089
• Fairfield Medical Center Hospital, Lancaster, OH, CCN 360072
• Adena Regional Medical Center Hospital, Chillicothe, OH, CCN 360159

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mwall145558@direct.bsmhealth.org

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.

• Columbus Radiology Corp

  • Diagnostic Radiology Physician
  • Columbus, OH
  • NPI 1669408159
  Medicare reassignment Care Compare group NPD
• Mercy Health Physicians Youngstown Specialty Care LLC

  • Surgery Physician
  • Youngstown, OH
  • NPI 1649892225
  Medicare reassignment NPD
• Mercy Health Physicians Youngstown, LLC

  • Family Medicine Physician
  • Youngstown, OH
  • NPI 1154636066
  Medicare reassignment NPD
• Mercy Health Physicians Youngstown LLC

  • Durable Medical Equipment & Medical Supplies
  • Boardman, OH
  • NPI 1750920245
  NPD
• Mercy Health Physicians Youngstown Specialty Care LLC

  • Durable Medical Equipment & Medical Supplies
  • Boardman, OH
  • NPI 1386316107
  NPD
• Amerirad Inc

  • Diagnostic Radiology Physician
  • Morgantown, WV
  • NPI 1790739985
  NPD (past)
• Shenandoah Medical Imaging Inc

  • Diagnostic Radiology Physician
  • Woodstock, VA
  • NPI 1598768087
  NPD (past)
• Team Physicians of Ohio, Inc.

  • Diagnostic Radiology Physician
  • Knoxville, TN
  • NPI 1386675106
  NPD (past)

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

• Adena Health System

  • General Acute Care Hospital
  • Chillicothe, OH
  • NPI 1902839673
  Care Compare affiliation
• Fairfield Medical Center

  • General Acute Care Hospital
  • Lancaster, OH
  • NPI 1467433763
  Care Compare affiliation
• Mercy Health - Defiance Hospital LLC

  • General Acute Care Hospital
  • Defiance, OH
  • NPI 1629011234
  Care Compare affiliation
• Mercy Health - St Vincent Medical Center LLC

  • General Acute Care Hospital
  • Toledo, OH
  • NPI 1467493551
  Care Compare affiliation
• Mercy Health - Tiffin Hospital LLC

  • General Acute Care Hospital
  • Tiffin, OH
  • NPI 1316994734
  Care Compare affiliation

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195430400000",
    "number": "1265405237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 W MAIN ST",
            "address_2": "PO BOX 305",
            "city": "BELLEVUE",
            "state": "OH",
            "postal_code": "448111328",
            "telephone_number": "419-483-4543",
            "fax_number": "419-483-0142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 LAKESIDE AVE E STE 1200",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441141172",
            "telephone_number": "216-362-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "MARY",
        "middle_name": "JEAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-09",
        "last_updated": "2007-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "35059303W",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0783022",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MC",
            "identifier": "P00286495",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000339383",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1018989380001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1018989380002",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1018989380003",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810008142",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiera Walker
• Torri Walker
• Tyesha Walker
• Zachary John Walker, MD
• Susan Lee Walkley
• Maureen A Wallace-King, NP
• Aaliyah Wallace
• Arianna Nevaeh Wallace
• Balinda Wallace
• Chelsea Frances Wallace, APRN, CNP

• Diagnostic Radiology Physician in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Diagnostic Radiology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; 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.