Shain S Wallis, DO

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

264957 Issued in NY

Practice address

5100 West Taft Rd
Ste 2a
Liverpool, NY 13088

Phone

(315) 452-2666

Fax

(315) 452-2669

NPI assigned

Jul 13, 2010

Last updated

Jan 29, 2024By the provider in NPPES

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 NY

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 1

Specialty

Diagnostic Radiology

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prospect Hill Radiology Group P CGroup PAC ID 6204806862, 16 clinicians

St Josephs Imaging Associates PLLCGroup PAC ID 5991775553, 16 clinicians

Mohawk Glen Radiology Associates of Cny PLLCGroup PAC ID 8224215900, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Joseph's Hospital Health Center Hospital, Syracuse, NY, CCN 330140

Merit-based Incentive Payment System (MIPS)

Final score

91.49 of 100Reported as group

Quality

77.62

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

68.93 of 100Reported as group

Quality

49.97

Improvement activities

40

Cost

88.17

Merit-based Incentive Payment System (MIPS)

Final score

83.48 of 100Reported as group

Quality

74.19

Improvement activities

40

Cost

73.55

Merit-based Incentive Payment System (MIPS)

Final score

83.1 of 100Reported as group

Quality

66.2

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: swallis2409850@direct.trinity-health.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mohawk Glen Radiology Associates of Cny PLLC

  • Diagnostic Radiology Physician
  • Rome, NY
  • NPI 1538466115
  Medicare reassignment Care Compare group NPD
• Prospect Hill Radiology Group P C

  • Diagnostic Radiology Physician
  • Syracuse, NY
  • NPI 1235122425
  Medicare reassignment Care Compare group NPD
• St. Josephs Imaging Associates PLLC

  • Diagnostic Radiology Physician
  • Liverpool, NY
  • NPI 1093709180
  Medicare reassignment Care Compare group NPD
• University Radiology Associates, LLP

  • Diagnostic Radiology Physician
  • Syracuse, NY
  • NPI 1215978184
  Medicare reassignment NPD

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

• St Josephs Hospital Health Center

  • General Acute Care Hospital
  • Syracuse, NY
  • NPI 1508815333
  Care Compare affiliation

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

{
    "created_epoch": "1278979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1356653729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4567 CROSSROADS PARK DR",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883589",
            "telephone_number": "315-295-2100",
            "fax_number": "315-295-2125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 WEST TAFT RD",
            "address_2": "STE 2A",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "13088",
            "telephone_number": "315-452-2666",
            "fax_number": "315-452-2669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "SHAIN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-13",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "264957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna Wagenblatt
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1831)
• Walgreen Co (Rite Aid #19573)
• Walgreen Co (Walgreens #19542)
• Walgreen Co (Rite Aid #10747)
• Austin Washburn
• Anthony R Watson, MD
• Rachel Webb, LMSW
• Travis Paul Webb
• Wegmans Food Markets, Inc. (Wegmans Pharmacy #034)

• Diagnostic Radiology Physician in Liverpool, NY
• Providers in Liverpool, NY by specialty
• Diagnostic Radiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; 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.