Lisa Marie Wallace, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

1-097840 Issued in AL

Practice address

777 Hemlock St
Macon, GA 31201-2102

Phone

(478) 633-1000

NPI assigned

Feb 26, 2008

Last updated

Jun 5, 2015By 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

• Lisa Marie Campbell Other name

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dale Medical CenterGroup PAC ID 3476466327, 29 clinicians

Ambulatory Management LLCGroup PAC ID 9436501178, 8 clinicians

Gut PCGroup PAC ID 3375589799, 53 clinicians

Epix Anesthesia of Alabama LLCGroup PAC ID 8022300748, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Medical Center Enterprise Hospital, Enterprise, AL, CCN 010049

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Epix Anesthesia of Alabama LLC

  • Anesthesiology Physician
  • Roswell, GA
  • NPI 1629427059

  AL, Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Ambulatory Management LLC

  • Certified Registered Nurse Anesthetist
  • Enterprise, AL
  • NPI 1003690744

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Dale Medical Center

  dba Ozark Family Medical Clinic

  • Family Medicine Physician
  • Ozark, AL
  • NPI 1538275342
  Medicare reassignment Care Compare group NPD
• Gut PC

  dba Digestive Health Specialist of the Southeast

  • Gastroenterology Physician
  • Dothan, AL
  • NPI 1073566006
  Medicare reassignment Care Compare group NPD
• Houston County Healthcare Authority

  dba Samc-Enterprise Medical Clinic

  • Internal Medicine Physician
  • Enterprise, AL
  • NPI 1619026606
  Medicare reassignment NPD
• Premier Anesthesia of Montgomery PC

  • Anesthesiology Physician
  • Montgomery, AL
  • NPI 1780636233

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Southern Alabama Surgery Center LLC

  dba Surgery Center South

  • Ambulatory Surgical Clinic/Center
  • Dothan, AL
  • NPI 1346349164

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Veronox Anesthesia, LLC

  • Anesthesiology Physician
  • Enterprise, AL
  • NPI 1669951604
  Medicare reassignment NPD
• Dale Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Ozark, AL
  • NPI 1215479357
  NPD
• Dale Medical Center

  • Certified Registered Nurse Anesthetist
  • Ozark, AL
  • NPI 1700081254

  Nurse Anesthetist, Certified Registered

  NPD
• Gut PC

  • Anesthesiology Physician
  • Dothan, AL
  • NPI 1790201903

  Nurse Anesthetist, Certified Registered

  NPD
• Houston County Healthcare Authority

  dba Southeast Alabama Medical Center Medical Clinics

  • Internal Medicine Physician
  • Dothan, AL
  • NPI 1538597349
  NPD

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

• QHG of Enterprise Inc

  dba Medical Center Enterprise

  • General Acute Care Hospital
  • Enterprise, AL
  • NPI 1720039712
  Care Compare affiliation

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

{
    "created_epoch": "1203984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433462400000",
    "number": "1548439375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "598 3RD ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312013357",
            "telephone_number": "478-633-6706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HEMLOCK ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312012102",
            "telephone_number": "478-633-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-26",
        "last_updated": "2015-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AL",
            "license": "1-097840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "CAMPBELL",
            "middle_name": "MARIE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Richard Alan Wall II
• Cleopatra Wallace, CRNA
• Danielle Wallace
• Franc Wallace, MD
• Heather E Wallace
• William Wallace Jr., MD
• Ryan C. Wallentine, PA-AA
• Waller Occupational Therapy and Consulting, LLC
• Eulanda Lara Waller, OTR/L
• Laura B Walsh, LPC

• Certified Registered Nurse Anesthetist in Macon, GA
• Providers in Macon, GA by specialty
• Certified Registered Nurse Anesthetist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.