Gerald Adrian Wallace, CRNA

Primary specialty

Registered NurseTaxonomy code 163W00000X

Practice address

1253 NW Canal Blvd
Redmond, OR 97756-1334

Phone

(541) 584-8131

NPI assigned

Jun 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Certified Registered Nurse

State licenses

Practice roles

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.

• Wallace Anesthesia Services PC

  • Certified Registered Nurse Anesthetist
  • Redmond, OR
  • NPI 1528000874

  Nurse Anesthetist, Certified Registered

  NPD (past) Authorized official
• Jefferson Anesthesiology Associates

  • Anesthesiology Physician
  • Pine Bluff, AR
  • NPI 1023005550
  NPD (past)

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1265478416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4008",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972084008",
            "telephone_number": "503-372-2740",
            "fax_number": "503-372-2754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1253 NW CANAL BLVD",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977561334",
            "telephone_number": "541-584-8131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "GERALD",
        "middle_name": "ADRIAN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OR",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029121",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores, Inc.
• Walgreen Co
• Alisha Walker, RN
• Anthony Blake Walker, PH.D.
• Wallace Anesthesia Services PC
• Owen Wallulatum, CRM
• Walmart Inc.
• Karen Jean Walz, PT
• Lauren L Wanamaker, L.M.T.
• Michael Joseph Wanamaker, OT/LP

• Registered Nurse in Redmond, OR
• Providers in Redmond, OR by specialty
• Registered Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.