NPIMap

Individual provider Active NPI

Thomas Witherspoon Wallace, MD

  • Clinical Cardiac Electrophysiology Physician
  • Little Rock, AR
National Provider Identifier
1295807733
Registry record updated Jun 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
E-6988 Issued in AR
Practice address
10100 Kanis Rd
Little Rock, AR 72205-6202
Phone
(501) 255-6000
Fax
(501) 255-6400
NPI assigned
Nov 13, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 21, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology Physician 207RC0001X E-6988 AR Primary

Addresses

Primary practice location

10100 Kanis Rd
Little Rock, AR 72205-6202

Mailing address

1807 Shadow LN
Little Rock, AR 72207-2015
Phone (501) 747-2124

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110714000128 AR Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology) 0840391090 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology)
Education
Emory University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10100 Kanis Rd
Little Rock, AR 72205-6202
Phone (501) 255-6000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair88

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E-6988ARMDClinical Cardiac Electrophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Vincent Infirmary Medical Center Current Accepting new patients
Heart Clinic Arkansas Current Accepting new patients
St. Vincent Infirmary Medical Center CurrentSince Mar 20, 2012 Accepting new patients
St Vincent Infirmary Medical Center CurrentSince Mar 20, 2012 Accepting new patients

Locations

10100 Kanis Rd
Little Rock, AR 72205
Phone (501) 255-6000

2 Saint Vincent Cir
Little Rock, AR 72205
Phone (501) 552-2680

1708 N Buerkle St
Stuttgart, AR 72160
Phone (870) 659-8050

Interoperability endpoints

  • Direct secure messaging: twallace458803@direct.stlukeshealth.org

Organizations & group practices 4

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.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466467200000",
    "number": "1295807733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1807 SHADOW LN",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722072015",
            "telephone_number": "501-747-2124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10100 KANIS RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056202",
            "telephone_number": "501-255-6000",
            "fax_number": "501-255-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "THOMAS",
        "middle_name": "WITHERSPOON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2016-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "AR",
            "license": "E-6988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.