Lydia Wallace

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

1024211 Issued in MA

Practice address

235 N Pearl St
Brockton, MA 02301-1794

Phone

(617) 414-5405

NPI assigned

Apr 16, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM, MA2 enrollments

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 2

Specialty

Emergency Medicine

Education

Tufts University School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Staffing Solutions IncGroup PAC ID 9830001650, 57 clinicians

BMC Affiliated Physicians, Inc.Group PAC ID 9830133123, 543 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Good Samaritan Medical Center Hospital, Brockton, MA, CCN 220111
• Lovelace Women'S Hospital Hospital, Albuquerque, NM, CCN 320017

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lwallace278879@ahs.direct-ci.com
• Direct secure messaging: lwallace264634@direct.bmc.masshiway.net

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.

• BMC Affiliated Physicians, Inc.

  • Internal Medicine Physician
  • Boston, MA
  • NPI 1245320910

  Emergency Medicine

  Medicare reassignment Care Compare group NPD
• Emergency Staffing Solutions Inc

  • Emergency Medicine Physician
  • Many, LA
  • NPI 1477590974

  NM

  Medicare reassignment Care Compare group NPD
• Las Cruces HB Medical Services LLC

  • Emergency Medicine Physician
  • Las Cruces, NM
  • NPI 1598446171
  Medicare reassignment NPD
• Southwest Emergency Medical Associates of NM PC

  • Emergency Medicine Physician
  • Las Cruces, NM
  • NPI 1720505571
  Medicare reassignment NPD

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

• Boston Medical Center - South Corporation

  • General Acute Care Hospital
  • Brockton, MA
  • NPI 1871329110
  Care Compare affiliation
• Lovelace Health System, LLC

  • General Acute Care Hospital
  • Albuquerque, NM
  • NPI 1982799375
  Care Compare affiliation

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

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754092800000",
    "number": "1417344581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVE STE 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182690",
            "telephone_number": "617-414-5405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 N PEARL ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023011794",
            "telephone_number": "617-414-5405"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "145 Harrison Ave",
            "address_2": "Sackler Center 4th floor",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021111802",
            "country_code": "US",
            "telephone_number": "161-763-6656",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 Hospital Loop NE",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871092129",
            "country_code": "US",
            "telephone_number": "615-928-6268",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LYDIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-16",
        "last_updated": "2025-08-02",
        "certification_date": "2025-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NM",
            "license": "MD2019-0840",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MA",
            "license": "1024211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "MD2019-08",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John F Walker, RPH
• Kelsie E Walker
• Andrew Russell Wall
• Emily Wall
• James Joseph Wall, R.PH.
• John Alexander Wallington, M.D.
• Kerry Walsh, PA-C
• Heather M. Walton Flynn, PH.D.
• Rosealiza Wan Zaid, DPT
• Bin Wang

• Emergency Medicine Physician in Brockton, MA
• Providers in Brockton, MA by specialty
• Emergency Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2025; 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.