Jean M. Wallner, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9104785 Issued in FL

Practice address

7001 N Dale Mabry Hwy Ste 10
Tampa, FL 33614

Phone

(813) 497-9661

Fax

(813) 615-8468

NPI assigned

Jan 15, 2007

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 identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Florida Hospital Physician Group IncGroup PAC ID 2365679057, 953 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventhealth Tampa Hospital, Tampa, FL, CCN 100173
• AdventHealth Carrollwood Hospital, Tampa, FL, CCN 100069

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• Direct secure messaging: jwallner73530@adventhealth.direct-ci.com

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.

• Florida Hospital Physician Group Inc

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1174955256
  Medicare reassignment Care Compare group
• Florida Heart & Vascular Associates, PL

  • Cardiovascular Disease Physician
  • Tampa, FL
  • NPI 1043302102
  NPD (past)
• Midatlantic Cardiovascular Associates PA

  • Cardiovascular Disease Physician
  • Baltimore, MD
  • NPI 1821084112
  NPD (past)
• Saint Joseph Medical Center , Inc.

  • Multi-Specialty Clinic/Center
  • Towson, MD
  • NPI 1699862961
  NPD (past)

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

• University Community Hospital, Inc

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1053321919
  Care Compare affiliation
• University Community Hospital, Inc

  • Clinical Medical Laboratory
  • Tampa, FL
  • NPI 1134766694

  Hospital

  Care Compare affiliation
• University Community Hospital, Inc

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1427068345
  Care Compare affiliation

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549929600000",
    "number": "1639220973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7001 N DALE MABRY HWY STE 10",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336143910",
            "telephone_number": "813-497-9661",
            "fax_number": "813-615-8468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7001 N DALE MABRY HWY STE 10",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33614",
            "telephone_number": "813-497-9661",
            "fax_number": "813-615-8468"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13330 Usf Laurel Dr",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336126601",
            "country_code": "US",
            "telephone_number": "813-974-2201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLNER",
        "first_name": "JEAN",
        "middle_name": "M.",
        "name_prefix": "Ms.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2019-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9104785",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017063300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "VRY4K",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seren Devol Wallen, PA-C
• Jennifer Lynn Waller, APRN
• Kenneth Ray Waller Jr., RBT
• Anthony David Emmanuel Wallitsch, DMD
• Robyn Wallman
• Louise Wallowitz
• Allen P (Phil) Walls, R.PH.
• Antonio Brian Walls
• Jordan Walls, MS CCC-SLP
• Preston Brice Walls

• Physician Assistant in Tampa, FL
• Providers in Tampa, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2019; 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.