Deborah Wallach, FNP-BC, OCN, PMN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95004542 Issued in CA

Practice address

9090 Wilshire Blvd
Suite 200
Beverly Hills, CA 90211-1850

Phone

(310) 888-8680

NPI assigned

Aug 31, 2016

Sex

Female

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: deborah.wallach@redondo.ikm.direct-ci.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.

• Torrance Health Association Inc

  dba Torrance Memorial Physician Network

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1083903124
  Medicare reassignment NPD
• Torrance Memorial Medical Center

  • Skilled Nursing Facility
  • Torrance, CA
  • NPI 1740268713
  NPD (past)

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

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476144000000",
    "number": "1326594144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 CAMINO REAL UNIT 102",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902774301",
            "telephone_number": "424-247-3150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9090 WILSHIRE BLVD",
            "address_2": "SUITE 200",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902111850",
            "telephone_number": "310-888-8680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACH",
        "first_name": "DEBORAH",
        "name_prefix": "Ms.",
        "credential": "FNP-BC, OCN, PMN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-31",
        "last_updated": "2016-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95004542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wallace Medical Group
• Wallace Medical Group, Inc
• Daniel J Wallace, M.D.
• Melanie L. Wallace, AMFT
• Paul Wesley Wallace, MD
• Megan Waller, RN
• Andrew Walsh
• Cameron Walsh
• Eileen P Walsh, MSN,FNP
• Walter a Rogoff MD Inc

• Family Nurse Practitioner in Beverly Hills, CA
• Providers in Beverly Hills, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2016; 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.