Jerrol B Wallace, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

R246272 Issued in MD

Practice address

4940 Eastern Ave
Baltimore, MD 21224-2735

Phone

(410) 550-0100

NPI assigned

Jan 31, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA, NH, MD, DC, GA, WV, MO7 enrollments

Enrollment records 7

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Duke University School of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Androscoggin Valley Hospital IncGroup PAC ID 2365350725, shared by 3 NPIs, 61 clinicians

Grady Memorial Hospital CorporationGroup PAC ID 7517032998, 365 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Androscoggin Valley Hospital Hospital, Berlin, NH, CCN 301310

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwallace806314@direct.hopkinsmedicine.org

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.

• Grady Memorial Hospital Corporation

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1114243813
  Medicare reassignment Care Compare group NPD
• Johns Hopkins University

  • Pain Medicine (Anesthesiology) Physician
  • Baltimore, MD
  • NPI 1922008549
  Medicare reassignment NPD
• North Calvert Anesthesiology Services LLC

  • Anesthesiology Physician
  • Baltimore, MD
  • NPI 1710360227
  Medicare reassignment NPD
• Capital Anesthesia Solutions of Missouri, LLC

  • Anesthesiology Physician
  • Rombauer, MO
  • NPI 1770185472
  Medicare reassignment NPD
• Hospitalist Medicine Physicians of Georgia - TCS, PC

  • Anesthesiology Physician
  • Columbus, GA
  • NPI 1033926191
  Medicare reassignment NPD
• Hospitalist Medicine Physicians of New York - Patchogue PC

  • Anesthesiology Physician
  • Patchogue, NY
  • NPI 1366920993

  NH

  Medicare reassignment NPD
• Hospitalist Medicine Physicians of West Virginia - South Charleston

  • Anesthesiology Physician
  • Princeton, WV
  • NPI 1063228120
  Medicare reassignment NPD
• Inova Cares - Community

  • Anesthesiology Physician
  • Fairfax, VA
  • NPI 1861131906

  DC

  Medicare reassignment NPD
• SMG Anesthesia Specialists LLC

  • Anesthesiology Physician
  • Virginia Beach, VA
  • NPI 1518205004
  Medicare reassignment NPD
• Surgical Anesthesia Associates, PLLC

  • Anesthesiology Physician
  • Washington, DC
  • NPI 1811930647

  VA

  Medicare reassignment NPD
• Virginia Anesthesia Services LLC

  • Anesthesiology Physician
  • Richmond, VA
  • NPI 1881205144
  Medicare reassignment NPD
• Androscoggin Valley Hospital Inc

  • General Practice Physician
  • Berlin, NH
  • NPI 1679526644
  Medicare reassignment

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

• Androscoggin Valley Hospital

  • Durable Medical Equipment & Medical Supplies
  • Berlin, NH
  • NPI 1235267451

  Hospital

  Care Compare affiliation
• Androscoggin Valley Hospital Inc

  • General Practice Physician
  • Berlin, NH
  • NPI 1679526644

  Hospital

  Care Compare affiliation
• Androscoggin Valley Hospital, Inc.

  • Critical Access Hospital
  • Berlin, NH
  • NPI 1386680593
  Care Compare affiliation

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613433600000",
    "number": "1316084932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6201 GREENLEIGH AVE",
            "city": "MIDDLE RIVER",
            "state": "MD",
            "postal_code": "212202004",
            "telephone_number": "410-933-6423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4940 EASTERN AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212242735",
            "telephone_number": "410-550-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JERROL",
        "middle_name": "B",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0024167758",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MD",
            "license": "R246272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candace Wallace, CPT
• Darrell Dewayne Wallace Jr., LGPC
• Darryl John Wallace, CSC-AD
• Desiree Wallace
• Edward Anthony Wallace
• Joey Lynn Wallace
• Lula Wallace, CAC-AD
• Matthew Tristan Wallace, M.D.
• Nancy Wallace, PHD
• Patrick William Wallace, PT

• Certified Registered Nurse Anesthetist in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Certified Registered Nurse Anesthetist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.