Donetta Wallace, P.A.-C
Individual provider Active NPI Physician Assistant · Paintsville, KY
NPI 1417958828 · NPPES record last updated Feb 1, 2022
Key facts
- NPI
- 1417958828
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA544 (KY)
- Practice address
- 336 N Mayo TRL
Paintsville, KY 41240-1804 - Phone
- (606) 789-8666
- Fax
- (606) 788-0253
- NPI assigned
- Aug 9, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 10
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Ashland Hospital Corporation
Practice addresses (Care Compare)
12100 Princeland Dr
Ashland, KY 41102-7885
Phone (606) 928-2963
2201 Lexington Ave
Ashland, KY 41101-2843
Phone (606) 408-4000
336 N Mayo TRL
Paintsville, KY 41240-1804
Phone (606) 789-8666
Hospital & facility affiliations
- Johnson-Magoffin Home Health Agency
- Caretenders - Louisa
- King'S Daughters' Medical Center
- Paintsville Arh Hospital
- Highlands Arh Regional Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 89.16 of 100
- Quality
- 77.42
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 77.62
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040226000281 | KY | Practitioner - Physician Assistant | 7113813130 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ashland Hospital Corporation | Current |
Accepting new patients | |
| Ashland Hospital Corporation | Current |
Accepting new patients | |
| Ashland Hospital Corporation | Physician Assistant | Past | Accepting new patients |
Locations
2201 Lexington Ave
Ashland, KY 41101
Phone (606) 268-2560
12100 Princeland Spur
Ashland, KY 41102
Phone (606) 928-2963
336 N Mayo Trl
Paintsville, KY 41240
Phone (606) 789-1031
354 N Mayo Trl
Paintsville, KY 41240
Phone (606) 372-0221
Interoperability endpoints
- dwallace79686@direct.kdhealth.us
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA544 | KY | |
| Physician Assistant | 363A00000X | PA544 | KY | Yes |
Addresses
Primary practice location
336 N Mayo TRL
Paintsville, KY 41240-1804
Mailing address
PO Box 2379
Ashland, KY 41105-2379
Phone (606) 408-9571
NPI Registry JSON
{
"created_epoch": "1123545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643673600000",
"number": "1417958828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2379",
"city": "ASHLAND",
"state": "KY",
"postal_code": "411052379",
"telephone_number": "606-408-9571",
"fax_number": "606-408-6061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "336 N MAYO TRL",
"city": "PAINTSVILLE",
"state": "KY",
"postal_code": "412401804",
"telephone_number": "606-789-8666",
"fax_number": "606-788-0253"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DONETTA",
"name_prefix": "Ms.",
"credential": "P.A.-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-09",
"last_updated": "2022-02-01",
"certification_date": "2022-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "KY",
"license": "PA544",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "KY",
"license": "PA544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paintsville, KY
- Gabrielle Waddles
- Wal-Mart Stores East LP
- Wal-Mart Stores East, LP
- Megan Nicole Walden
- Walgreen Co
- Angela Webb
- Tammy Webb
- Jaime Welch
- Whitaker National Corporation
- Krystal Wicker
All providers in Paintsville, KY · Physician Assistant in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.