Gabriel Abraham Wallace, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

036142476 Issued in IL

Practice address

12251 S 80TH Ave Ste 1520
Palos Heights, IL 60463-1290

Phone

(708) 923-4200

Fax

(708) 923-4201

NPI assigned

Mar 29, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 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

Vascular Surgery

Education

University of Washington School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Palos Community Hospital Hospital, Palos Heights, IL, CCN 140062
• Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
• Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281

Merit-based Incentive Payment System (MIPS)

Final score

95.19 of 100Reported as apm

Quality

83.05

Promoting interoperability

100

Improvement activities

40

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.

• Northwestern Medical Faculty Foundation

  • Multi-Specialty Clinic/Center
  • Carol Stream, IL
  • NPI 1346235314
  Medicare reassignment Care Compare group NPD
• Vascular Surgery Associates, PLLC

  • Vascular Surgery Physician
  • Chicago Ridge, IL
  • NPI 1538791793
  Medicare reassignment NPD
• Northwestern Medical Faculty Foundation

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
  • NPI 1417718479
  NPD
• Central Dupage Physician Group

  • Family Medicine Physician
  • Carol Stream, IL
  • NPI 1033149844
  NPD (past)

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

• Central Dupage Hospital Association

  • General Acute Care Hospital
  • Winfield, IL
  • NPI 1003864810
  Care Compare affiliation
• Central Dupage Hospital Association

  • Psychiatric Hospital Unit
  • Winfield, IL
  • NPI 1740230895
  Care Compare affiliation
• Northwestern Memorial Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1497859649
  Care Compare affiliation
• Palos Community Hospital

  • Psychiatric Hospital Unit
  • Palos Heights, IL
  • NPI 1184699118
  Care Compare affiliation
• Palos Community Hospital

  • General Acute Care Hospital
  • Palos Heights, IL
  • NPI 1851386692
  Care Compare affiliation

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

{
    "created_epoch": "1332979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1609142074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 84992",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606894992",
            "telephone_number": "918-710-3710",
            "fax_number": "918-770-0058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12251 S 80TH AVE STE 1520",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631290",
            "telephone_number": "708-923-4200",
            "fax_number": "708-923-4201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1959 NE Pacific St",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981956410",
            "country_code": "US",
            "telephone_number": "206-543-3687",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10258 Southwest Hwy Ste A",
            "address_purpose": "LOCATION",
            "city": "Chicago Ridge",
            "state": "IL",
            "postal_code": "604151361",
            "country_code": "US",
            "telephone_number": "708-346-9533",
            "fax_number": "708-499-4312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "GABRIEL",
        "middle_name": "ABRAHAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-29",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036142476",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "IL",
            "license": "036142476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036142476",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Waishwell, M.A.
• Walgreen Co
• Walgreen Co.
• Walid Habbal DDS PC
• Tenille Tenille Wallace-Bell, LPC
• Joseph Wallace, DPT
• Katherine M Walter, PA-C
• Nicholas Ryan Walters, PA-C
• Payton Ward
• Steven R Wardell, M.D.

• Vascular Surgery Physician in Palos Heights, IL
• Providers in Palos Heights, IL by specialty
• Vascular Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; 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.