Individual provider Active NPI

Christopher Jacob Wallace, MD

  • Emergency Medicine Physician
  • Mount Vernon, WA
National Provider Identifier
1386393551
Registry record updated Nov 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD.MD.61629334 Issued in WA
Practice address
300 Hospital Pkwy
Mount Vernon, WA 98274-2100
Phone
(360) 424-4111
NPI assigned
Mar 23, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD.MD.61629334 WA Primary

Addresses

Primary practice location

300 Hospital Pkwy
Mount Vernon, WA 98274-2100

Mailing address

1431 SW 1St Ave
Ocala, FL 34471-6500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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

Enrollment IDStateProvider typePAC IDDetails
I20250716002250 WA Practitioner - Emergency Medicine 9436664547 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwest Emergency Physicians LLCGroup PAC ID 3476462334, 267 clinicians

Practice addresses (Care Compare)

330 S Stillaguamish Ave
Arlington, WA 98223-1642
Phone (360) 435-2133

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.MD.61629334WAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Emergency Physicians LLC Emergency Medicine CurrentSince Jul 1, 2025 Accepting new patients

Locations

330 S Stillaguamish Ave
Arlington, WA 98223
Phone (360) 435-2133

1415 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 416-5750

888 Swift Blvd
Richland, WA 99352
Phone (509) 942-2115

1717 S J St
Tacoma, WA 98405
Phone (253) 426-4101

Interoperability endpoints

  • Direct secure messaging: cwallace62968@skagit.direct-ci.com

Organizations & group practices 1

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 2

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

NPI Registry JSON

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

{
    "created_epoch": "1647993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763510400000",
    "number": "1386393551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 SW 1ST AVE",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344716500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HOSPITAL PKWY",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982742100",
            "telephone_number": "360-424-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CHRISTOPHER",
        "middle_name": "JACOB",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-23",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD.MD.61629334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.