Wallace Russell Jenkins, MD

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

183800 Issued in NY

Practice address

503 Grasslands Rd
Ste 200
Valhalla, NY 10595

Phone

(914) 304-5288

Fax

(914) 345-1755

NPI assigned

Jul 28, 2005

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 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Boston Children'S Health Physicians, LLP

  • Pediatrics Physician
  • Hawthorne, NY
  • NPI 1467454967

  Adolescent Medicine

  Medicare reassignment NPD
• Boston Childrens Health Physicians LLP

  • Clinical Medical Laboratory
  • Sleepy Hollow, NY
  • NPI 1588651079
  NPD
• Richmond Children'S Center, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Yonkers, NY
  • NPI 1568548162
  NPD (past)

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374537600000",
    "number": "1487654653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 GRASSLANDS RD",
            "address_2": "STE 200",
            "city": "VALHALLA",
            "state": "NY",
            "postal_code": "105951503",
            "telephone_number": "914-304-5288",
            "fax_number": "914-345-1755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 GRASSLANDS RD",
            "address_2": "STE 200",
            "city": "VALHALLA",
            "state": "NY",
            "postal_code": "10595",
            "telephone_number": "914-304-5288",
            "fax_number": "914-345-1755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENKINS",
        "first_name": "WALLACE",
        "middle_name": "RUSSELL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2013-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NY",
            "license": "183800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01210104",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hoore Jannat, M.D.
• Nolberto Jaramillo Jr., DO
• Sean Stephen Jarboe, PA-C
• Edward Jarvis, MD
• JDS Occupational Therapy Associates PC
• Erin Marie Jennings, NP
• Kenneth Brian Jezierski, MD
• Omkar Jha, M.D.
• Alice Jiang, DO
• Alicia Jiang, MD

• Pediatric Adolescent Medicine Physician in Valhalla, NY
• Providers in Valhalla, NY by specialty
• Pediatric Adolescent Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.