NPIMap

Individual provider Active NPI

Paul Wallace, M.D.

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1639287212
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD458894 Issued in PA
Practice address
7806 Cresheim Rd
Philadelphia, PA 19118-4003
Phone
(215) 930-6630
Fax
(866) 404-2729
NPI assigned
Aug 25, 2006
Last updated
Aug 23, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD458894 PA Primary

Addresses

Primary practice location

7806 Cresheim Rd
Philadelphia, PA 19118-4003

Mailing address

801 Joe Mann Blvd Ste P-6
Midland, MI 48642-8900
Phone (989) 791-2455

Other identifiers 1

IdentifierTypeStateIssuer
00A688900MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20160831001814 PA Practitioner - Internal MedicinePractitioner - Hospitalist 7810883667 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of California, San Francisco School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Philadelphia, PA 19118
Phone (215) 930-6630

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fornance Physician Services, Inc Internal Medicine CurrentSince Feb 1, 2021 Accepting new patients
Fornance Physician Services, Inc Current Accepting new patients
University of Penn - Medical Group Internal Medicine Current Accepting new patients
Insight Home Physicians, PC Internal Medicine CurrentSince Aug 11, 2020 Accepting new patients
University of Penn-Medical Group Internal Medicine CurrentSince Sep 1, 2016 Accepting new patients
HR Physician Services CurrentSince Mar 29, 2022 Accepting new patients
HR Physician Services Internal Medicine CurrentSince Mar 29, 2022 Accepting new patients
Fornance Physician Services, Inc. CurrentSince Feb 1, 2021 Accepting new patients
Gateway Mobile Medical, LLC CurrentSince Feb 1, 2022 Accepting new patients
Conon Medical CurrentSince Feb 1, 2022 Accepting new patients
University of Penn-Medical Group CurrentSince Sep 1, 2016 Accepting new patients
HR Physician Services Internal Medicine Current Accepting new patients
Inpatient Management Medical Group Inc Internal Medicine Past Accepting new patients
Avant Inpatient Services Medical Group, Inc Internal Medicine Past Accepting new patients
Sutter East Bay Medical Foundation Past Accepting new patients
Sutter East Bay Medical Foundation Internal Medicine Past Accepting new patients

Locations

204 W Buttles St
Midland, MI 48640

1648 Huntingdon Pike
Meadowbrook, PA 19046
Phone (215) 938-3413

3400 Spruce St
Fl 5
Philadelphia, PA 19104
Phone (215) 662-2777

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

559 W Germantown Pike
West Norriton, PA 19403
Phone (484) 622-1000

Organizations & group practices 17

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 17

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1639287212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 JOE MANN BLVD STE P-6",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486428900",
            "telephone_number": "989-791-2455",
            "fax_number": "989-791-1392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7806 CRESHEIM RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191184003",
            "telephone_number": "215-930-6630",
            "fax_number": "866-404-2729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "PAUL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD458894",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A688900",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.