NPIMap

Individual provider Active NPI

Erik Allen Wallace, MD

  • Internal Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1477523843
Registry record updated Jul 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DR.0054121 Issued in CO
Practice address
2877 E Fountain Blvd
Colorado Springs, CO 80910-2312
Phone
(719) 454-6009
Fax
(719) 258-1319
NPI assigned
Jan 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 23305 OK
Internal Medicine Physician 207R00000X DR.0054121 CO Primary

Addresses

Primary practice location

2877 E Fountain Blvd
Colorado Springs, CO 80910-2312

Mailing address

PO Box 746081
Atlanta, GA 30374-6081

Other practice location 1

4380 Austin Bluffs Pkwy
Colorado Springs, CO 80918
Phone (719) 454-6010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221018000932 CO Practitioner - Internal Medicine 7113829128 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2000
Medicare assignment
May accept Medicare assignment
Group practices
Oak Street Health Physicians Group of Colorado PLLCGroup PAC ID 9032585054, 34 clinicians

Practice addresses (Care Compare)

4380 Austin Bluffs Pkwy
Colorado Springs, CO 80918-2932
Phone (719) 454-6010

Hospital & facility affiliations

  • At Home Healthcare Home health agency, Denver, CO, CCN 067255
  • Uch-Memorial Health System Hospital, Colorado Springs, CO, CCN 060022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Oak Street Health Physicians Group of Colorado, PLLC Internal Medicine CurrentSince Oct 21, 2022 Accepting new patients
Oak Street Health Physicians Group of Colorado, PLLC Internal Medicine CurrentSince Oct 21, 2022 Accepting new patients

Locations

4380 Austin Bluffs Pkwy
Colorado Springs, CO 80918
Phone (719) 454-6010

2877 E Fountain Blvd
Colorado Springs, CO 80910
Phone (719) 454-6009

Organizations & group practices 2

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.

Hospital & facility affiliations 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1477523843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746081",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2877 E FOUNTAIN BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809102312",
            "telephone_number": "719-454-6009",
            "fax_number": "719-258-1319"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4380 Austin Bluffs Pkwy",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "80918",
            "country_code": "US",
            "telephone_number": "719-454-6010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ERIK",
        "middle_name": "ALLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "23305",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0054121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.