Peter David Wallens, M.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C000573 Issued in NC

Practice address

1801 E 5TH St
Suite 212
Charlotte, NC 28204-2379

Phone

(704) 373-1000

Fax

(704) 373-1468

NPI assigned

Dec 26, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275698540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3304 SELWYN FARMS LN APT 1",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282095006",
            "telephone_number": "704-523-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 E 5TH ST",
            "address_2": "SUITE 212",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042379",
            "telephone_number": "704-373-1000",
            "fax_number": "704-373-1468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLENS",
        "first_name": "PETER",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "M.S.W.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C000573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shana Dale Wallace, MD
• Sidiqat Wallace
• Terry W Wallace, M.D.
• Tonia Wallace, PMHNP-BC
• Stephen Lee Wallenhaupt, MD
• Hannah R Waller
• John Christian Waller, LPC
• Angela Wallick
• Daniel Brown Wallihan, M.D.
• Casey Raye Wallin, DNP, CRNA

• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.