Michael Robert Wallace, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

599 Issued in GA

Practice address

2800 N Oak St
Valdosta, GA 31602-1716

Phone

(229) 244-1211

Fax

(229) 244-2721

NPI assigned

Oct 2, 2006

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 GA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valdosta Foot and Ankle Clinic, P.C.Group PAC ID 1658362439, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SGMC Health Hospital, Valdosta, GA, CCN 110122

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: michaelwallace@vfacc.allscriptsdirect.net

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.

• Valdosta Foot & Ankle Clinic, P.C.

  • Foot & Ankle Surgery Podiatrist
  • Valdosta, GA
  • NPI 1699975375
  Medicare reassignment Care Compare group NPD Authorized official
• Valdosta Foot & Ankle Surgery Center, P.C.

  • Ambulatory Surgical Clinic/Center
  • Valdosta, GA
  • NPI 1912196494
  Medicare reassignment NPD

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

• South Georgia Medical Center Inc

  • General Acute Care Hospital
  • Valdosta, GA
  • NPI 1144096553
  Care Compare affiliation

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379462400000",
    "number": "1295828416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021716",
            "telephone_number": "229-244-1211",
            "fax_number": "229-244-2721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021716",
            "telephone_number": "229-244-1211",
            "fax_number": "229-244-2721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MICHAEL",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2013-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "GA",
            "license": "599",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000480029131",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shea Walker
• Shelia De Lois Walker, CADC-II
• Tiffany Kay Walker, RD
• Dekoya Wallace-Adams
• Jahqwale Wallace
• Shantonitt Wallace
• Mary Ann Waller, CCC-SLP
• Stacey Diane Walters, ATC
• Eric M Ward, M.D.
• Kyla Ward, LPC

• Foot & Ankle Surgery Podiatrist in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Foot & Ankle Surgery Podiatrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; 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.