William David Wallace, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

28885 Issued in MS

Practice address

969 Lakeland Dr
Jackson, MS 39216-4606

Phone

(601) 200-2000

NPI assigned

Apr 17, 2018

Last updated

Jul 12, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

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

Diagnostic Radiology

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakeland Radiologists P aGroup PAC ID 4183683089, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Greenwood Leflore Hospital Hospital, Greenwood, MS, CCN 250099
• St Dominic-Jackson Memorial Hospital Hospital, Jackson, MS, CCN 250048
• Merit Health River Region Hospital, Vicksburg, MS, CCN 250031
• Merit Health River Oaks Hospital, Flowood, MS, CCN 250138
• Tyler Holmes Memorial Hospital Cah Hospital, Winona, MS, CCN 251312

Merit-based Incentive Payment System (MIPS)

Final score

90.58 of 100Reported as group

Quality

95

Improvement activities

40

Cost

75.31

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lakeland Radiologists P a

  • Diagnostic Radiology Physician
  • Jackson, MS
  • NPI 1861428351
  Medicare reassignment Care Compare group NPD
• Flowood Mississippi Imaging LLC

  • Radiology Clinic/Center
  • Flowood, MS
  • NPI 1861954083
  NPD

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

• River Oaks Hospital LLC

  dba Merit Health River Oaks

  • General Acute Care Hospital
  • Flowood, MS
  • NPI 1396792032
  Care Compare affiliation
• St Dominic-Jackson Memorial Hospital

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1306876065
  Care Compare affiliation
• State of Mississippi - University of Mississippi Medical Center

  dba UMMC Greenwood Hospital

  • General Acute Care Hospital
  • Greenwood, MS
  • NPI 1699714717
  Care Compare affiliation
• Tyler Holmes Memorial Hospital

  • Critical Access Hospital
  • Winona, MS
  • NPI 1205868627
  Care Compare affiliation
• Vicksburg Healthcare LLC

  dba Merit Health River Region

  • General Acute Care Hospital
  • Vicksburg, MS
  • NPI 1215981303
  Care Compare affiliation

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

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1679060438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23073",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253073",
            "telephone_number": "601-200-6162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164606",
            "telephone_number": "601-200-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "WILLIAM",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-17",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MS",
            "license": "28885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Wall
• Christina Blair Wallace, MD
• Erin E Wallace
• Gary Robert Wallace, PTA
• Quentin Wallace
• William H. Wallace
• Donald E. Waller
• Mary Marshall Waller
• Anna D Walley, FNP
• Elgin Kenneth Walley, D.D.S.

• Diagnostic Radiology Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Diagnostic Radiology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2024; 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.