NPIMap

Individual provider Active NPI

James Michael Wallace, M.D.

  • Emergency Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1477707685
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD60247504 Issued in WA
Practice address
1528 Laird Ave
Salt Lake City, UT 84105-1730
Phone
(503) 475-8549
NPI assigned
Nov 14, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 7471598-1205 UT
Emergency Medicine Physician 207P00000X MD60247504 WA Primary

Addresses

Primary practice location

1528 Laird Ave
Salt Lake City, UT 84105-1730

Mailing address

821 S 600 E
Salt Lake City, UT 84102-3507
Phone (503) 475-8549

Other identifiers 1

IdentifierTypeStateIssuer
MD13915OtherRIMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20111216000359 WA Practitioner - Emergency Medicine 4082807136 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Oregon Health Sciences University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwest Emergency Physicians LLCGroup PAC ID 3476462334, 267 clinicians

Practice addresses (Care Compare)

1415 E Kincaid St
Mount Vernon, WA 98274-4126
Phone (360) 424-4111

1717 S J St
Tacoma, WA 98405-4933
Phone (253) 627-4101

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.4 of 100Reported as group
Quality
77.09
Promoting interoperability
100
Improvement activities
40

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.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
7471598-1205UTMDEmergency Medicine Physician
MD60247504WAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Sound Inpatient Physicians PLLC Family Medicine Current Accepting new patients
Sound Physicians Emergency Medicine of Washington PLLC Emergency Medicine CurrentSince Jul 1, 2022 Accepting new patients
Cogent Healthcare of Washington, PC Family Medicine CurrentSince Jul 1, 2022 Accepting new patients
Northwest Emergency Physicians LLC Emergency Medicine CurrentSince Mar 1, 2012 Accepting new patients
South Sound Inpatient Physicians PLLC Family Medicine CurrentSince Jul 1, 2022 Accepting new patients
South Sound Inpatient Physicians, PLLC Family Medicine CurrentSince Jul 1, 2022 Accepting new patients
Emergency Physicians Integrated Care, LLC Emergency Medicine Past Accepting new patients

Locations

330 S Stillaguamish Ave
Arlington, WA 98223
Phone (360) 435-2133

407 14th Ave SE
Puyallup, WA 98372
Phone (253) 697-4000

888 Swift Blvd
Richland, WA 99352
Phone (509) 942-2115

2000 Hospital Dr
Sedro Woolley, WA 98284
Phone (360) 856-6021

1717 S J St
Tacoma, WA 98405
Phone (253) 426-4101

Interoperability endpoints

  • Direct secure messaging: jwallace30125@skagit.direct-ci.com
  • Direct secure messaging: jwallace434167@direct.peacehealth.org

Organizations & group practices 7

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 5

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

NPI Registry JSON

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

{
    "created_epoch": "1226620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1477707685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 S 600 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841023507",
            "telephone_number": "503-475-8549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1528 LAIRD AVE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841051730",
            "telephone_number": "503-475-8549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JAMES",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-11-14",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "UT",
            "license": "7471598-1205",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD60247504",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "MD13915",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.