Richard Peterkin Wallace, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME85690 Issued in FL

Practice address

1001 S Fort Harrison Ave
Suite 101
Clearwater, FL 33756-3941

Phone

(727) 441-5044

Fax

(727) 441-5008

NPI assigned

May 18, 2006

Last updated

Sep 27, 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 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

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

Family PracticeAlso: Sports Medicine

Education

Meharry Medical College School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bayside Urgent Care Center Inc.Group PAC ID 3375700180, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Bayside Urgent Care Center Inc.

  • Urgent Care Clinic/Center
  • Clearwater, FL
  • NPI 1619257755
  Medicare reassignment Care Compare group Authorized official
• Baycare Urgent Care, LLC

  • General Practice Physician
  • New Port Richey, FL
  • NPI 1629514070

  Family Medicine

  NPD (past)
• Bayfront Enterprises Inc

  dba Bayfront Convenient Care Clinics

  • Urgent Care Clinic/Center
  • St Petersburg, FL
  • NPI 1710963236
  NPD (past)

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474934400000",
    "number": "1275586448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 S FORT HARRISON AVE",
            "address_2": "SUITE 101",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337563905",
            "telephone_number": "727-441-5044",
            "fax_number": "727-441-5008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S FORT HARRISON AVE",
            "address_2": "SUITE 101",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337563941",
            "telephone_number": "727-441-5044",
            "fax_number": "727-441-5008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "RICHARD",
        "middle_name": "PETERKIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2016-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME85690",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "FL",
            "license": "ME85690",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270183900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE NUMBER",
            "identifier": "P00294408",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Michael Wall, MD
• Cassandra Ann Wallace-Wical, ARNP
• Laura Wallace, ARNP
• Matthew A Wallace
• Paul R. Wallace, M.D.
• Walmart Pharmacy
• Christopher Walsh, MA
• Diana Hertel Walter, PA-C
• Thomas S Walter, MD
• Lynn Arines Walters, DAOM, AP

• Family Medicine Physician in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.