Darryl Wallace, MD

Primary specialty

Gynecologic Oncology PhysicianTaxonomy code 207VX0201X

License

R5048 Issued in MO

Practice address

4321 Washington St
Suite 4000
Kansas City, MO 64111-5961

Phone

(816) 932-4549

NPI assigned

Jun 6, 2006

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

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Saint Luke'S Hospital of Kansas City

  • Prosthetic/Orthotic Supplier
  • Kansas City, MO
  • NPI 1700896958
  NPD (past)
• Saint Lukes Cancer Institute LLC

  • Surgical Oncology Physician
  • Kansas City, MO
  • NPI 1962458901

  Gynecologic Oncology

  NPD (past)
• Saint Lukes Physician Group II LLC

  • Surgery Physician
  • Kansas City, MO
  • NPI 1750335337
  NPD (past)

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349913600000",
    "number": "1477592210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 504407",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631504407",
            "telephone_number": "816-932-7947",
            "fax_number": "816-932-7957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4321 WASHINGTON ST",
            "address_2": "SUITE 4000",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641115961",
            "telephone_number": "816-932-4549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DARRYL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2012-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "KS",
            "license": "415529",
            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "MO",
            "license": "R5048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201094802",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHCARE USA",
            "identifier": "33690",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KC",
            "identifier": "09381035",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "910000367",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4602518",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "7400202",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Wall
• Jeffrey W Wall, M.D
• Terry J Wall, MD
• Allie Wallace, DO
• Cynthia Calbert Wallace, M.D.
• Dustin P Wallace, PHD
• Julie Wallace
• Laura Wallace
• Sabrina Wallace
• Sarah Jane Wallace, APN

• Gynecologic Oncology Physician in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Gynecologic Oncology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.