Daniel J Wall, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A74764 Issued in CA

Practice address

3860 Blackhawk Rd Ste 140
Danville, CA 94506-4832

Phone

(925) 837-6000

NPI assigned

Sep 21, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Dermatology

Education

Rutgers, Robert Woood Johnson Medical School, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hayes B Gladstone MD PCGroup PAC ID 4587987474, 6 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Hayes B. Gladstone, MD, PC.

  • Dermatology Physician
  • Danville, CA
  • NPI 1376947978
  Medicare reassignment Care Compare group NPD
• Csi Medical Group

  • MOHS-Micrographic Surgery Physician
  • San Pedro, CA
  • NPI 1871909804

  Dermatology

  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  Dermatology

  Medicare reassignment NPD
• Hayes B. Gladstone, MD, PC.

  • Medical Specialty Clinic/Center
  • Danville, CA
  • NPI 1447028063
  NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Redwood City, CA
  • NPI 1639252604

  Dermatology

  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1508852013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 BLACKHAWK RD STE 140",
            "city": "DANVILLE",
            "state": "CA",
            "postal_code": "945064832",
            "telephone_number": "925-837-6000",
            "fax_number": "925-837-6011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3860 BLACKHAWK RD STE 140",
            "city": "DANVILLE",
            "state": "CA",
            "postal_code": "945064832",
            "telephone_number": "925-837-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1808 Tice Valley Blvd",
            "address_purpose": "LOCATION",
            "city": "Walnut Creek",
            "state": "CA",
            "postal_code": "945952224",
            "country_code": "US",
            "telephone_number": "925-837-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALL",
        "first_name": "DANIEL",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A74764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "975 Sereno Drive",
            "city": "Vallejo",
            "state": "CA",
            "country_code": "US",
            "postal_code": "94589",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Vortex Psychiatry, Inc.
• Verna Vu
• Lauren Waitrovich, MFT
• Walgreen Co
• Judianne Marguriette Walker, D.P.M
• Adam Gregory Wallach, M.D.
• Laurie Elizabeth Wallis, R.N.
• Jessica Kaixin Wang, PT, DPT
• Pamela Wang, M.D.
• Deanna Marie Ward, M.D.

• Dermatology Physician in Danville, CA
• Providers in Danville, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.