David W Wallace, MD MBA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

22054 Issued in KY

Practice address

515 Hospital Dr
Suite 1
Shelbyville, KY 40065-1640

Phone

(502) 633-3525

Fax

(502) 633-8075

NPI assigned

Oct 14, 2005

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

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in KY

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

Merit-based Incentive Payment System (MIPS)

Final score

78.96 of 100Reported as group

Quality

56.12

Promoting interoperability

100

Improvement activities

40

Cost

73.73

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dwallace11294@uoflhealth-dm.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.

• University of Louisville Physicians, Inc.

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1366722316

  Family Medicine, KY

  Medicare reassignment NPD
• University of Louisville Physicians, Inc.

  • Diagnostic Radiology Physician
  • Louisville, KY
  • NPI 1316294127
  NPD
• University of Louisville Physicians, Inc.

  • Family Medicine Physician
  • Louisville, KY
  • NPI 1386910917

  Family Medicine

  NPD
• Family Physician Associates PSC

  • Family Medicine Physician
  • Shelbyville, KY
  • NPI 1053300681

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1376532168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LIBERTY ST STE 800",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021428",
            "telephone_number": "502-633-3525",
            "fax_number": "502-633-8075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 HOSPITAL DR",
            "address_2": "SUITE 1",
            "city": "SHELBYVILLE",
            "state": "KY",
            "postal_code": "400651640",
            "telephone_number": "502-633-3525",
            "fax_number": "502-633-8075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DAVID",
        "middle_name": "W",
        "credential": "MD MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-14",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "22054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "0100487",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00872496",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000048268",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64220544",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East, LP
• Ronald E Waldridge Sr., MD
• Walgreen Co
• Walgreen Co
• Jenna Walker, SLP
• Paige Walls, OTR/L
• Kayla Walters
• Emily Ward
• Madison Warrick, SLP
• Jennifer Lynn Wartman, COTA

• All providers in Shelbyville, KY
• Family Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.