NPIMap

Individual provider Active NPI

Eric L Wallace, D.O.

  • Interventional Cardiology Physician
  • Coeur D Alene, ID
National Provider Identifier
1568658243
Registry record updated Jul 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
O-0839 Issued in ID
Practice address
700 W Ironwood Dr
320
Coeur D Alene, ID 83814-2656
Phone
(208) 625-5250
NPI assigned
Sep 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 03263 KY
Internal Medicine Physician 207R00000X 2007-014326 NC
Cardiovascular Disease Physician 207RC0000X O0839 ID
Interventional Cardiology Physician 207RI0011X OP60505950 WA
Interventional Cardiology Physician 207RI0011X O-0839 ID Primary

Addresses

Primary practice location

700 W Ironwood Dr
320
Coeur D Alene, ID 83814-2656

Mailing address

700 W Ironwood Dr
320
Coeur D Alene, ID 83814-2656
Phone (208) 625-5250

Other practice location 1

415 6TH St
Lewiston, ID 83501
Phone (208) 750-7507

Other practice location 2

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone (208) 625-5084

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ewallace611210@direct.multicare.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150519002539 ID Practitioner - Interventional Cardiology 6709939291 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional Cardiology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kootenai Health IncGroup PAC ID 1355792276, 394 clinicians

Practice addresses (Care Compare)

1055 Riverside Ave
Orofino, ID 83544-9029
Phone (208) 476-5777

1300 E Mullan Ave
Suite 1300
Post Falls, ID 83854-6057
Phone (208) 625-5630

1701 Lincoln Way
Coeur D Alene, ID 83814-2537
Phone (208) 625-4900

1919 Lincoln Way
Coeur D Alene, ID 83814-2527

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051

423 N 3Rd Ave
Suite 355
Sandpoint, ID 83864-1511
Phone (208) 263-2505

520 N 3Rd Ave
Sandpoint, ID 83864-1507
Phone (208) 265-7111

700 W Ironwood Dr
Suite 320
Coeur D Alene, ID 83814-4485
Phone (208) 625-5250

701 Lewiston St
Cottonwood, ID 83522-9750
Phone (208) 962-3267

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting55
Pacemaker insertion or repair1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
03263KYMDInternal Medicine Physician
2007-014326NCMDInternal Medicine Physician
O0839IDMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kootenai Health, Inc. CurrentSince Jan 1, 2024 Accepting new patients
St Joseph Hospital LLC Internal Medicine CurrentSince Mar 5, 2019 Accepting new patients
Kootenai Health, Inc. Current Accepting new patients
Incyte Pathology, PLLC Current Accepting new patients
Kootenai Health, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Spokane Valley Family Medicine P.S. Past Accepting new patients

Locations

2003 Kootenai Health Way
Coeur D Alene, ID 83814
Phone (208) 625-5085

700 W Ironwood Dr
Ste 320
Coeur D Alene, ID 83814
Phone (208) 625-5250

700 W Ironwood Dr
Ste 350
Coeur D Alene, ID 83814
Phone (208) 625-5222

701 Lewiston St
Cottonwood, ID 83522
Phone (208) 962-3251

740 McKinley Ave
Kellogg, ID 83837
Phone (208) 783-1267

415 6th St
Lewiston, ID 83501
Phone (208) 750-7445

338 6th St
Lewiston, ID 83501
Phone (208) 746-3320

821 21st Ave
Lewiston, ID 83501
Phone (208) 799-3422

1300 E Mullan Ave
Ste 700
Post Falls, ID 83854
Phone (208) 625-5564

1119 Highland Ave
Ste 4
Clarkston, WA 99403
Phone (509) 254-0080

62 W 7th Ave
Ste 310
Spokane, WA 99204
Phone (509) 847-2500

Interoperability endpoints

  • Direct secure messaging: ewallace611210@direct.multicare.org

Organizations & group practices 7

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.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1189987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753401600000",
    "number": "1568658243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR",
            "address_2": "320",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142656",
            "telephone_number": "208-625-5250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR",
            "address_2": "320",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142656",
            "telephone_number": "208-625-5250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "415 6TH ST",
            "address_purpose": "LOCATION",
            "city": "Lewiston",
            "state": "ID",
            "postal_code": "83501",
            "country_code": "US",
            "telephone_number": "208-750-7507",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2003 Kootenai Health Way",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838146051",
            "country_code": "US",
            "telephone_number": "208-625-5084",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ERIC",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-17",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "03263",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2007-014326",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "ID",
            "license": "O0839",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "WA",
            "license": "OP60505950",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "ID",
            "license": "O-0839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ewallace611210@direct.multicare.org",
            "affiliation": "N",
            "address_1": "700 W Ironwood Dr",
            "address_2": "320",
            "city": "Coeur D Alene",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838142656",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Coeur D Alene, ID

Sources for this page

Verify at the official NPI Registry.