Michael Wallis, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN112816 Issued in LA

Practice address

1634 Elton Rd
Jennings, LA 70546-3614

Phone

(800) 893-9698

NPI assigned

Mar 10, 2014

Sex

Male

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 1

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PCP Urgent Care Holdings LLCGroup PAC ID 5092016816, 47 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• PCP Urgent Care Holdings LLC

  • Urgent Care Clinic/Center
  • Baton Rouge, LA
  • NPI 1245601038

  LA

  Medicare reassignment Care Compare group NPD
• Hospital Service District 1 of East Baton Rouge Parish

  • General Acute Care Hospital
  • Zachary, LA
  • NPI 1962437681

  LA

  Medicare reassignment NPD
• Jefferson Davis Emergency Group LLC

  • Emergency Medicine Physician
  • Jennings, LA
  • NPI 1043289572

  LA, Nurse Practitioner

  Medicare reassignment NPD
• St Tammany Emergency Physicians Group LLC

  • Emergency Medicine Physician
  • Covington, LA
  • NPI 1891187654

  LA

  Medicare reassignment NPD
• PCP Urgent Care Holdings LLC

  • Durable Medical Equipment & Medical Supplies
  • New Orleans, LA
  • NPI 1598657025
  Care Compare group NPD
• PCP Urgent Care Holdings LLC

  • Durable Medical Equipment & Medical Supplies
  • Baton Rouge, LA
  • NPI 1073223939
  Care Compare group
• PCP Urgent Care Holdings LLC

  • Durable Medical Equipment & Medical Supplies
  • Brusly, LA
  • NPI 1114637071
  Care Compare group
• PCP Urgent Care Holdings LLC

  • Durable Medical Equipment & Medical Supplies
  • Baton Rouge, LA
  • NPI 1164132403
  Care Compare group
• PCP Urgent Care Holdings LLC

  • Durable Medical Equipment & Medical Supplies
  • Prairieville, LA
  • NPI 1184334435
  Care Compare group
• PCP Urgent Care Holdings LLC

  • Durable Medical Equipment & Medical Supplies
  • Hammond, LA
  • NPI 1285488304
  Care Compare group
• PCP Urgent Care Holdings LLC

  • Durable Medical Equipment & Medical Supplies
  • Baton Rouge, LA
  • NPI 1326758285
  Care Compare group
• PCP Urgent Care Holdings LLC

  • Durable Medical Equipment & Medical Supplies
  • Baton Rouge, LA
  • NPI 1588374821
  Care Compare group

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

{
    "created_epoch": "1394409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579996800000",
    "number": "1285050690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "address_2": "SUITE 201",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1634 ELTON RD",
            "city": "JENNINGS",
            "state": "LA",
            "postal_code": "705463614",
            "telephone_number": "800-893-9698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19900 Old Scenic Hwy Ste H",
            "address_purpose": "LOCATION",
            "city": "Zachary",
            "state": "LA",
            "postal_code": "707917368",
            "country_code": "US",
            "telephone_number": "225-570-2618",
            "fax_number": "225-570-8539",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "MICHAEL",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-10",
        "last_updated": "2020-01-26",
        "certification_date": "2020-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "RN112816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2356003",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Magen B Voiselle, SLP
• Wal-Mart Stores East LP
• Wal-Mart Stores Louisiana, LLC
• Walgreen Co
• Conkichi Walker
• Carolyn Washington
• Claude Kimball Watkins
• Brandi Lynn Welch, PHARMD
• Wellness Clinic Psychiatry, LLC
• West Behavioral, LLC

• All providers in Jennings, LA
• Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2020; 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.