Mathew Cary Wallace, M.D.

Primary specialty

Pain Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084P2900X

License

MD.29202 Issued in AL

Practice address

4228 Lomac St Ste 2
Montgomery, AL 36106-2929

Phone

(919) 928-2351

NPI assigned

Sep 21, 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

Other names 1

• Mathew Cary Wallack Former name

Medicare fee-for-service enrollment

Enrolled in AL

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Indiana Neuroscience Assoc Inc

  • Neurology Physician
  • Indianapolis, IN
  • NPI 1144305400
  NPD (past)
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)
• Singing River Health System

  • Multi-Specialty Clinic/Center
  • Gautier, MS
  • NPI 1083893937
  NPD (past)
• Sun Coast Pain Management, P.a.

  • Specialist
  • Ocean Springs, MS
  • NPI 1407803919
  NPD (past)

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1306945829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4228 LOMAC ST STE 2",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361062929",
            "telephone_number": "919-928-2351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4228 LOMAC ST STE 2",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361062929",
            "telephone_number": "919-928-2351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MATHEW",
        "middle_name": "CARY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": "AL",
            "license": "MD.29202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MATHEW",
            "last_name": "WALLACK",
            "middle_name": "CARY",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Keisa T Walker
• Roszell Nicole Walker
• Leigh A Wallace, SP
• Maci Wallace, PT
• Marilynn R. Wallace, PHARM.D.
• Takova Wallace, PHARMD
• Gregory Allen Waller, M.D.
• Jacqueline Rae Waller, PHARMD
• Wallers Transport Services LLC
• Cooper Walley, RN

• All providers in Montgomery, AL
• Pain Medicine (Psychiatry & Neurology) Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; 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.