Erin Elizabeth Wallace, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

M9077 Issued in TX

Practice address

252 Matlock Rd Ste 330
Mansfield, TX 76063-4294

Phone

(817) 557-5437

Fax

(817) 539-0476

NPI assigned

May 17, 2007

Last updated

Nov 4, 2019By the provider in NPPES

Sex

Female

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 TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ewallace406998@direct.childrens.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Dallas Physician Medical Services for Children Inc

  dba Children's Health Medical Group

  • Pediatrics Physician
  • Dallas, TX
  • NPI 1194153650
  Medicare reassignment NPD
• Medical Clinic of North Texas, PLLC

  dba USMD Physician Services

  • Internal Medicine Physician
  • Arlington, TX
  • NPI 1033167234

  Pediatrics

  Medicare reassignment NPD
• Dallas Physician Medical Services for Children Inc

  dba Children's Health Medical Group

  • Pediatrics Physician
  • Dallas, TX
  • NPI 1558407908
  NPD
• Medical Clinic of North Texas PLLC

  • Radiation Oncology Clinic/Center
  • Arlington, TX
  • NPI 1184131625
  NPD

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572825600000",
    "number": "1396952263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "252 MATLOCK RD STE 330",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760634294",
            "telephone_number": "817-557-5437",
            "fax_number": "817-539-0476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "252 MATLOCK RD STE 330",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760634294",
            "telephone_number": "817-557-5437",
            "fax_number": "817-539-0476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ERIN",
        "middle_name": "ELIZABETH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2019-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "M9077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197051904",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084933301",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197051902",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "195476005",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #05213)
• Christina Dianne Walker, LPC
• Julie M Walker, LVN
• Kate Walker, PA-C
• Sara Walker, MA
• Bailee Ann Waller, M.S., CCC-SLP
• Walnut Creek Counseling PLLC
• Walnut Creek Residential Services, Inc. (Walnut Creek)
• Walnut Ridge Orthodontics
• Kaylee Walston

• Pediatrics Physician in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.