Philip C Wallace, MD

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

MD152056 Issued in OR

Practice address

2115 NE Wyatt CT.
101
Bend, OR 97701-6324

Phone

(541) 323-6280

Fax

(541) 323-6288

NPI assigned

Nov 9, 2007

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

Medicare fee-for-service enrollment

Enrolled in OR

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

Sports Medicine

Education

Meharry Medical College School of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Central Oregon Spine and Sports LLCGroup PAC ID 0244515641, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Charles Medical Center Prineville Hospital, Prineville, OR, CCN 381313

Merit-based Incentive Payment System (MIPS)

Final score

86.65 of 100Reported as group

Quality

91.7

Promoting interoperability

97

Improvement activities

40

Cost

66.31

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

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

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.

• Central Oregon Spine and Sports, LLC

  • Physical Medicine & Rehabilitation Physician
  • Bend, OR
  • NPI 1497293054
  Medicare reassignment Care Compare group NPD
• Northwest Neuro Nerve Monitoring, LLC

  • Other Technician
  • Eugene, OR
  • NPI 1841581048
  Medicare reassignment NPD
• Northwest Medical Specialist LLC

  dba NW Brain and Spine

  • Neurological Surgery Physician
  • Bend, OR
  • NPI 1588674279
  Medicare reassignment
• Physicians of Central Oregon, LLC

  • Orthopaedic Surgery Physician
  • Bend, OR
  • NPI 1679884027
  NPD (past)

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

• St. Charles Health System, Inc.

  dba St. Charles Prineville

  • Critical Access Hospital
  • Prineville, OR
  • NPI 1710160445
  Care Compare affiliation

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

{
    "created_epoch": "1194566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494374400000",
    "number": "1629258322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 NE WYATT CT",
            "address_2": "SUITE 101",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017678",
            "telephone_number": "541-323-6280",
            "fax_number": "541-323-6288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 NE WYATT CT.",
            "address_2": "101",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016324",
            "telephone_number": "541-323-6280",
            "fax_number": "541-323-6288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "PHILIP",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-09",
        "last_updated": "2017-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "OR",
            "license": "MD152056",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "TX",
            "license": "P1432",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Wall
• Cathleen Wallace
• Jim F Wallace, PT
• Kendall Wallace
• Michelle Wallace, LCSW
• Susan K Wallace IV
• Austin Waller
• Jessica Wallick
• Erin M Walling, MD
• Walmart Inc. (Walmart Pharmacy 10-2075)

• Physical Medicine & Rehabilitation Physician in Bend, OR
• Providers in Bend, OR by specialty
• Physical Medicine & Rehabilitation Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2017; 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.