Active NPI
Pamela Wall, PA
- Medical Physician Assistant
- Indianapolis, IN
National Provider Identifier
1417239591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 10000381A
- Practice address
- 931 E 86TH St
Suite 104
Indianapolis, IN 46240-1860 - Phone
- (317) 257-1484
- Fax
- (317) 257-1488
- NPI assigned
- Sep 14, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 10000381A | IN | Primary |
Addresses
Primary practice location
931 E 86TH St
Suite 104
Indianapolis, IN 46240-1860
Mailing address
931 E 86TH St
Suite 104
Indianapolis, IN 46240-1860
Phone (317) 257-1484
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dermatology and Plastic Surgery Associates, S.C. | Medical | Past | Accepting new patients |
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.
-
- Procedural Dermatology Physician
- Joliet, IL
- NPI 1700987328
Medical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410739200000",
"number": "1417239591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "931 E 86TH ST",
"address_2": "SUITE 104",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462401860",
"telephone_number": "317-257-1484",
"fax_number": "317-257-1488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "931 E 86TH ST",
"address_2": "SUITE 104",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462401860",
"telephone_number": "317-257-1484",
"fax_number": "317-257-1488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "PAMELA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-14",
"last_updated": "2014-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "IN",
"license": "10000381A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.