Jonathan Wallace, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

036108563 Issued in IL

Practice address

4885 Hoffman Blvd
Suite 400
Hoffman Estates, IL 60192-3726

Phone

(847) 255-9697

Fax

(847) 255-9697

NPI assigned

Mar 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

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

General Surgery

Education

Tufts University School of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bonaventure Medical Foundation LLCGroup PAC ID 7517863178, 164 clinicians

Suburban Surgical Care Specialists SCGroup PAC ID 7113992918, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Alexian Brothers Medical Center 1 Hospital, Elk Grove Village, IL, CCN 140258
• St Alexius Medical Center Hospital, Hoffman Estates, IL, CCN 140290
• Saint Joseph Hospital-Elgin Hospital, Elgin, IL, CCN 140217

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IAEDBA

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.

• Suburban Surgical Care Specialists, S.C.

  • Surgery Physician
  • Hoffman Estates, IL
  • NPI 1871613489
  Medicare reassignment Care Compare group NPD
• Bonaventure Medical Foundation, LLC

  • Family Medicine Physician
  • Elk Grove Village, IL
  • NPI 1588775647
  Medicare reassignment Care Compare group

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

• Alexian Brothers Medical Center

  • General Acute Care Hospital
  • Elk Grove Village, IL
  • NPI 1265577191
  Care Compare affiliation
• Saint Joseph Hospital - Elgin LLC

  • General Acute Care Hospital
  • Elgin, IL
  • NPI 1922846351
  Care Compare affiliation
• St. Alexius Medical Center

  • General Acute Care Hospital
  • Hoffman Estates, IL
  • NPI 1376644385
  Care Compare affiliation

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1568422012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4885 HOFFMAN BLVD",
            "address_2": "SUITE 400",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "601923726",
            "telephone_number": "847-255-9697",
            "fax_number": "847-255-9697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4885 HOFFMAN BLVD",
            "address_2": "SUITE 400",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "601923726",
            "telephone_number": "847-255-9697",
            "fax_number": "847-255-9697"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "955 Beisner Rd",
            "address_purpose": "LOCATION",
            "city": "Elk Grove Village",
            "state": "IL",
            "postal_code": "600073475",
            "country_code": "US",
            "telephone_number": "847-640-5666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-27",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036108563",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036108563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036108563",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jonathan.wallace.1@380.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "955 Beisner Rd",
            "city": "Elk Grove Village",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600073475",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Walgreen Co
• Walgreen Co
• Walgreen Co.
• Holly Ann Walicek, ATC
• Andrea Danielle Walker, MD
• Michael G. Ward, M.D.
• Jennifer Ware, DNP, PMHNP-BC
• Natalie Jeanne Warnes
• Margaret P Wasson, LCPC
• Robert Allen Watson, PSY.D.

• Surgery Physician in Hoffman Estates, IL
• Providers in Hoffman Estates, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; 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.