Elise F Wallace, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

4301077878 Issued in MI

Practice address

1701 South Blvd E
Suite 200
Rochester Hills, MI 48307-6122

Phone

(248) 997-5805

Fax

(248) 997-5811

NPI assigned

Nov 14, 2005

Last updated

Oct 23, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Elise Diane Fischer Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Obstetrics/Gynecology

Education

Wayne State University School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oakland Macomb Obstetrics and Gynecology PCGroup PAC ID 4183673015, 23 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130
• Beaumont Hospital, Troy Hospital, Troy, MI, CCN 230269
• Ascension Providence Rochester Hospital Hospital, Rochester, MI, CCN 230254

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: elisewallace@omog.allscriptsdirect.net
• Direct secure messaging: ewallace11805@direct.beaumont.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Oakland Macomb Obstetrics & Gynecology, PC

  • Obstetrics & Gynecology Physician
  • Rochester Hills, MI
  • NPI 1760424139
  Medicare reassignment Care Compare group NPD
• Beaumont Medical Group Hospital -Based Services

  • Hospitalist Physician
  • Royal Oak, MI
  • NPI 1427567858
  Medicare reassignment NPD
• Anesthesia Associates of Ann Arbor, PLLC

  • Anesthesiology Physician
  • Westland, MI
  • NPI 1669581997
  NPD (past)

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

• Henry Ford Health Rochester Hospital

  • General Acute Care Hospital
  • Rochester, MI
  • NPI 1437176203
  Care Compare affiliation
• William Beaumont Hospital

  dba Beaumont Hospital, Troy

  • General Acute Care Hospital
  • Troy, MI
  • NPI 1306825997
  Care Compare affiliation
• William Beaumont Hospital

  dba Beaumont Hospital, Royal Oak

  • General Acute Care Hospital
  • Royal Oak, MI
  • NPI 1689653305
  Care Compare affiliation
• William Beaumont Hospital

  dba Beaumont Hospital, Grosse Pointe

  • General Acute Care Hospital
  • Grosse Pointe, MI
  • NPI 1932396017
  Care Compare affiliation

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

{
    "created_epoch": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603411200000",
    "number": "1538140835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 SOUTH BLVD E",
            "address_2": "SUITE 200",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483076122",
            "telephone_number": "248-997-5805",
            "fax_number": "248-997-5811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 SOUTH BLVD E",
            "address_2": "SUITE 200",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483076122",
            "telephone_number": "248-997-5805",
            "fax_number": "248-997-5811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ELISE",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-14",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "4301077878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ewallace11805@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "1701 South Blvd E",
            "address_2": "Suite 200",
            "city": "Rochester Hills",
            "state": "MI",
            "country_code": "US",
            "postal_code": "483076122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ELISE",
            "last_name": "FISCHER",
            "middle_name": "DIANE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Walgreen Co (Walgreens #09125)
• Walgreen Co (Walgreens #04660)
• Walgreen Co (Walgreens #07888)
• Monique Walk, NP
• Rubi Walker, BS,MS
• Catherine Ann Waller, M.D.
• Angela Walt, RD
• Sara Walters, ANP-BC
• Abdul Waqas, MD
• Warby Parker Inc.

• Obstetrics & Gynecology Physician in Rochester Hills, MI
• Providers in Rochester Hills, MI by specialty
• Obstetrics & Gynecology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2020; 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.