NPIMap

Individual provider Active NPI

Allison Paulk Wall, M.D.

  • Hematology & Oncology Physician
  • Gulfport, MS
National Provider Identifier
1346446671
Registry record updated Jul 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
20162 Issued in MS
Practice address
1340 Broad Ave
Suite 270
Gulfport, MS 39501-2404
Phone
(228) 575-1234
Fax
(228) 575-1230
NPI assigned
Jun 24, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 20162 MS Primary

Addresses

Primary practice location

1340 Broad Ave
Suite 270
Gulfport, MS 39501-2404

Mailing address

PO Box 1810
Gulfport, MS 39502-1810
Phone (228) 575-1234

Other identifiers 1

IdentifierTypeStateIssuer
04183295MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080607000021 MS Practitioner - Hematology/OncologyPractitioner - Internal Medicine 0648340349 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Internal Medicine
Education
University of Alabama School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

1340 Broad Ave
Gulfport, MS 39501-2460

1340 Broad Ave
Gulfport, MS 39501-2464

1340 Broad Ave
Gulfport, MS 39501-2465

4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 867-3152

920 Tommy Munro Dr
Suite 100
Biloxi, MS 39532-2150
Phone (228) 575-1800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
20162MSMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Current Accepting new patients
Memorial Hospital at Gulfport CurrentSince Mar 15, 2014 Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients

Locations

1756 Popps Ferry Rd
Ste A
Biloxi, MS 39532
Phone (228) 865-3200

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

Interoperability endpoints

  • Direct secure messaging: awall@direct.mhg.com

Organizations & group practices 4

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.

Hospital & facility affiliations 69

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

View all 69

NPI Registry JSON

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

{
    "created_epoch": "1182643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405036800000",
    "number": "1346446671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1810",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395021810",
            "telephone_number": "228-575-1234",
            "fax_number": "228-575-1240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 BROAD AVE",
            "address_2": "SUITE 270",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012404",
            "telephone_number": "228-575-1234",
            "fax_number": "228-575-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "ALLISON",
        "middle_name": "PAULK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-24",
        "last_updated": "2014-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MS",
            "license": "20162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04183295",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.