Nicole Marie Wallis, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

70944 Issued in MN

Practice address

1200 Grant Blvd W
Wabasha, MN 55981-1042

Phone

(651) 565-4531

NPI assigned

Jun 6, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH, MN2 enrollments

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 2

Specialty

Emergency Medicine

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Saint Elizabeths Hospital of Wabasha IncGroup PAC ID 5092619387, 93 clinicians

Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Elizabeth Medical Center Hospital, Wabasha, MN, CCN 241335
• Cleveland Clinic Avon Hospital Hospital, Avon, OH, CCN 360364
• Bellin Memorial Hospital Hospital, Green Bay, WI, CCN 520049
• Cleveland Clinic Hospital, Cleveland, OH, CCN 360180
• Akron General Medical Center Hospital, Akron, OH, CCN 360027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nwallis717728@direct.gundersenhealth.org
• Direct secure messaging: nwallis4575@direct.metrohealth.org
• Direct secure messaging: nwallis717728@direct.emplifyhealth.org
• Direct secure messaging: nwallis13942@direct.ccf.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.

• Saint Elizabeths Hospital of Wabasha Inc

  • Critical Access Hospital
  • Wabasha, MN
  • NPI 1659355600
  Medicare reassignment Care Compare group NPD
• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Medicare reassignment Care Compare group NPD
• Cleveland Clinic Health Services Professional Association, Inc

  • General Practice Physician
  • Cleveland, OH
  • NPI 1770082471
  Medicare reassignment NPD
• The Metrohealth System

  • Multi-Specialty Clinic/Center
  • Cleveland, OH
  • NPI 1053353896

  Emergency Medicine

  Medicare reassignment NPD
• Saint Elizabeths Hospital of Wabasha Inc

  • Clinic/Center
  • Wabasha, MN
  • NPI 1073050274
  NPD
• Saint Elizabeths Hospital of Wabasha Inc

  • Community/Retail Pharmacy
  • Wabasha, MN
  • NPI 1912334913
  NPD
• Euclid Hospital Cleveland Clinic Health System

  • General Acute Care Hospital
  • Euclid, OH
  • NPI 1457403016
  NPD
• The Metrohealth System

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1700828852
  NPD
• The Metrohealth System

  • Pharmacy
  • Cleveland, OH
  • NPI 1992529911
  NPD

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

• Saint Elizabeths Hospital of Wabasha Inc

  • Critical Access Hospital
  • Wabasha, MN
  • NPI 1659355600
  Care Compare affiliation
• Akron General Medical Center

  • General Acute Care Hospital
  • Akron, OH
  • NPI 1821035940
  Care Compare affiliation
• Bellin Memorial Hospital Inc.

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1891740585
  Care Compare affiliation
• Cleveland Clinic Avon Hospital

  • General Acute Care Hospital
  • Avon, OH
  • NPI 1346607017
  Care Compare affiliation
• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Care Compare affiliation

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657584000000",
    "number": "1346443728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 GRANT BLVD W",
            "city": "WABASHA",
            "state": "MN",
            "postal_code": "559811042",
            "telephone_number": "651-565-4531"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Perkins Sq",
            "address_2": "Akron Children's Hospital",
            "address_purpose": "LOCATION",
            "city": "Akron",
            "state": "OH",
            "postal_code": "44308",
            "country_code": "US",
            "telephone_number": "330-543-8452",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-06",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "70944",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35089618",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nwallis717728@direct.gundersenhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct messaging address",
            "address_1": "1200 Grant Blvd W",
            "city": "Wabasha",
            "state": "MN",
            "country_code": "US",
            "postal_code": "559811042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jon A Vanloon, MD
• Wabasha County Social Services
• Wabasha Dentistry LLC
• Wabasha-Kellogg #811
• Matthew Wagner
• Julie L Walsh
• Wenden Recovery Services of Wabasha
• Malinda Jean Wise, MSW, LICSW
• Wodele Enterprises Incorporated

• Emergency Medicine Physician in Wabasha, MN
• Providers in Wabasha, MN by specialty
• Emergency Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2022; 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.