Individual provider Active NPI

Patrick William Wallace, PT

  • Physical Therapist
  • Baltimore, MD
National Provider Identifier
1427294875
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
24718 Issued in MD
Practice address
2700 Quarry Lake Dr Ste 300
Baltimore, MD 21209-3746
Phone
(410) 377-8900
Fax
(410) 377-0576
NPI assigned
Jan 6, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 8524 CT
Physical Therapist 225100000X 030964-1 NY
Physical Therapist 225100000X 24718 MD Primary

Addresses

Primary practice location

2700 Quarry Lake Dr Ste 300
Baltimore, MD 21209-3746

Mailing address

2700 Quarry Lake Dr Ste 300
Baltimore, MD 21209-3746
Phone (410) 377-8900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170525000707 MD Practitioner - Physical Therapist in Private Practice 0446398630 Reassigns benefits to 3 organizations
I20200408002077 DC Practitioner - Physical Therapist in Private Practice 0446398630 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2700 Quarry Lake Dr
Baltimore, MD 21209-3742
Phone (410) 377-8900

Merit-based Incentive Payment System (MIPS)

Final score
86.05 of 100Reported as group
Quality
89.12
Improvement activities
40
Cost
73.46

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
030964NYMDDentist
030964-1NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Centers for Advanced Orthopaedics, LLC Current Accepting new patients
Centers for Advanced Orthopaedics, LLC CurrentSince Jan 13, 2025 Accepting new patients
Ati Holdings, LLC Physical Therapist CurrentSince Dec 1, 2016 Accepting new patients
Ati Holdings, LLC Physical Therapist CurrentSince Dec 1, 2016 Accepting new patients
Centers for Advanced Orthopaedics, LLC Physical Therapist CurrentSince Jan 13, 2025 Accepting new patients
Orthopaedic Associates of Central Maryland, PA Past Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001

2700 Quarry Lake Dr
Ste 300
Baltimore, MD 21209

2021A Emmorton Rd
Ste 110
Bel Air, MD 21015
Phone (410) 515-0006

10710 Charter Dr
Ste 300
Columbia, MD 21044
Phone 4106441880450

1510 Rock Spring Rd
Ste C
Forest Hill, MD 21050
Phone (410) 420-3619

4 Park Center Ct
Ste 200
Owings Mills, MD 21117

120 Westminster Pike
Ste 200
Reisterstown, MD 21136

52 Rising Sun Town Ctr
Rising Sun, MD 21911
Phone (410) 658-0100

11271 New Hampshire Ave
Silver Spring, MD 20904
Phone (240) 485-1280

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1231200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1427294875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 QUARRY LAKE DR STE 300",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093746",
            "telephone_number": "410-377-8900",
            "fax_number": "410-377-0576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 QUARRY LAKE DR STE 300",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093746",
            "telephone_number": "410-377-8900",
            "fax_number": "410-377-0576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "PATRICK",
        "middle_name": "WILLIAM",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-06",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "8524",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "030964-1",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "24718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.