Raymond B Wallace, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

44478-021 Issued in WI

Practice address

111 E Wisconsin Ave
Suite 2000
Milwaukee, WI 53202-4815

Phone

(414) 290-6720

Fax

(414) 290-6755

NPI assigned

Jul 6, 2006

Last updated

Sep 26, 2016By the provider in NPPES

Sex

Male

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 2

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

Specialty

Emergency Medicine

Education

Mid West Medical College, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

DHHS IHS Phoenix AreaGroup PAC ID 0244405629, 54 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Parker Indian Health Center Hospital, Parker, AZ, CCN 031307

Merit-based Incentive Payment System (MIPS)

Final score

70.2 of 100Reported as group

Quality

74.9

Improvement activities

40

Cost

20.37

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• DHHS IHS Phoenix Area

  dba Chemehuevi Health Clinic

  • Federal Public Health Clinic/Center
  • Havasu Lake, CA
  • NPI 1396022026

  TX

  Medicare reassignment Care Compare group NPD
• DHHS IHS Phoenix Area

  dba Parker Indian Hospital

  • Critical Access Hospital
  • Parker, AZ
  • NPI 1851678585
  NPD

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

• DHHS IHS Phoenix Area

  dba Parker Indian Hospital

  • Critical Access Hospital
  • Parker, AZ
  • NPI 1851678585
  Care Compare affiliation

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474848000000",
    "number": "1437181153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 CORAL DR",
            "address_2": "STE A",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531861483",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E WISCONSIN AVE",
            "address_2": "SUITE 2000",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532024815",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "RAYMOND",
        "middle_name": "B",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2016-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "44478-021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "930122235",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43500600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Latrice Shemon Wallace, RN
• Lyndsey Wallace, PSYD
• Megan A Wallace, BA
• Michael David Wallace, LCSW
• Prestyne S. Wallace
• Renae Wallace
• Stephanie Wallace
• Veronica Wallace
• Jacqueline Marie Wallenkamp, LPN
• Michael Waller

• Emergency Medicine Physician in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Emergency Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2016; 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.