William Robert Wallace, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

L.5697R Issued in AL

Practice address

1601 University Blvd E
Tuscaloosa, AL 35404-2920

Phone

(205) 349-2273

NPI assigned

Apr 15, 2022

Last updated

Jul 16, 2024By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

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

Family Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Island Medical Alabama LLCGroup PAC ID 3072682103, 24 clinicians

Immh Scottsboro LLCGroup PAC ID 2567787344, 15 clinicians

Tuscaloosa Medcenter North, LLCGroup PAC ID 9537167721, 24 clinicians

Tuscaloosa Medcenter South LLCGroup PAC ID 6305813221, 23 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cullman Regional Medical Center Hospital, Cullman, AL, CCN 010035

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15818/brand/1/csg/1/fhir/r4
• Direct secure messaging: william.wallace.1@31652.direct.athenahealth.com
• Direct secure messaging: william.wallace.p1@direct.umc.nextgenshare.com

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.

• Immh Scottsboro LLC

  • Emergency Medicine Physician
  • Scottsboro, AL
  • NPI 1558762393
  Medicare reassignment Care Compare group NPD
• Island Medical Alabama LLC

  • Emergency Medicine Physician
  • Cullman, AL
  • NPI 1104097666
  Medicare reassignment Care Compare group NPD
• Tuscaloosa Medcenter North, LLC

  • Family Medicine Physician
  • Northport, AL
  • NPI 1972518777
  Medicare reassignment Care Compare group NPD
• Tuscaloosa Medcenter South, LLC

  • Family Medicine Physician
  • Tuscaloosa, AL
  • NPI 1689689481
  Medicare reassignment Care Compare group NPD
• Medcenter Demopolis, LLC

  • Family Medicine Physician
  • Demopolis, AL
  • NPI 1184913030
  Medicare reassignment NPD
• Urgent Care Northwest PC

  • Family Medicine Physician
  • Jasper, AL
  • NPI 1548456494
  Medicare reassignment NPD
• Medcenter Fayette, LLC

  • Family Medicine Physician
  • Fayette, AL
  • NPI 1235590001
  NPD (past)
• Medcenter Primary Care, LLC

  dba MedCenter NorthRiver

  • Family Medicine Physician
  • Northport, AL
  • NPI 1922546357
  NPD (past)
• Urgent Care Northwest PC

  • Family Medicine Physician
  • Hazel Green, AL
  • NPI 1508749342
  NPD (past)
• Urgent Care Northwest PC

  • Family Medicine Physician
  • Huntsville, AL
  • NPI 1881577625
  NPD (past)
• Urgent Care Northwest PC

  • Family Medicine Physician
  • Hartselle, AL
  • NPI 1942183785
  NPD (past)

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

• Cullman Regional Medical Center, Inc

  • General Acute Care Hospital
  • Cullman, AL
  • NPI 1114919339
  Care Compare affiliation

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

{
    "created_epoch": "1649980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1437892676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 PETER BRYCE BLVD",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354017457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 UNIVERSITY BLVD E",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354042920",
            "telephone_number": "205-349-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "850 Peter Bryce Blvd",
            "address_purpose": "LOCATION",
            "city": "Tuscaloosa",
            "state": "AL",
            "postal_code": "354017457",
            "country_code": "US",
            "telephone_number": "205-348-1770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "WILLIAM",
        "middle_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-15",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "L.5697R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Johnna Junkin Walker, CRNA
• Octavia Mechelle Breazeale Walker, RN
• Paul Walker, PHARM.D.
• Joseph Claude Wallace, M.D.
• Sylvester Darren Wallace, LMSW, ACSW, C-ASWCM
• Valerie Walters, LGSW
• Preston Rosario Walthour
• Eddie Ling-Tse Wang, M.D.
• L Charles Ward, PH.D.
• Traonda Ward

• Family Medicine Physician in Tuscaloosa, AL
• Providers in Tuscaloosa, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; 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.