Brandon M Wallace, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

E5705 Issued in CA

Practice address

1300 S Sunset Ave
West Covina, CA 91790-3342

Phone

(323) 269-5205

NPI assigned

Aug 8, 2018

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

Medicare fee-for-service enrollment

Enrolled in CA

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

R Franklin University of Med & Sci/Chicago Medical School, 2018

Medicare assignment

May accept Medicare assignment

Group practices

Complete Care Community Health Center, IncGroup PAC ID 3779494190, 45 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: brandon.wallace.p1@direct.ccchcenter.nextgenshare.com

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.

• Complete Care Community Health Center, Inc

  • PACE Provider Organization
  • Los Angeles, CA
  • NPI 1215113964
  Medicare reassignment Care Compare group NPD
• Home Foot Care, Inc.

  • Podiatrist
  • Van Nuys, CA
  • NPI 1447480785
  Medicare reassignment NPD
• Stanley K Mathis DPM Inc

  • Podiatrist
  • San Clemente, CA
  • NPI 1649737651
  Medicare reassignment NPD
• Complete Care Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Visalia, CA
  • NPI 1316729403
  NPD
• Complete Care Community Health Center, Inc

  • PACE Provider Organization
  • South Gate, CA
  • NPI 1811397888
  NPD
• Michael D. Kotzen, Inc.

  • Foot & Ankle Surgery Podiatrist
  • Valley Village, CA
  • NPI 1013105972
  NPD

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

{
    "created_epoch": "1533686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762387200000",
    "number": "1316426679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 S SUNSET AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 S SUNSET AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903342",
            "telephone_number": "323-269-5205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BRANDON",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-08",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E5705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co.
• Cyrena Walker
• Gary Blaine Walker, PA-C
• Juleen Walker
• Tiffany Eugenia Walker, 373H00000X
• Walmart Inc.
• Walter Lam DDS a Professional Corporation
• Walter Lam DDS, a Professional Corp.
• Alice Wambui, NP
• Joline Roxas Wan

• Foot & Ankle Surgery Podiatrist in West Covina, CA
• Providers in West Covina, CA by specialty
• Foot & Ankle Surgery Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2025; 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.