Thomas M Wallace, M.D.

Primary specialty

Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X

License

G42269 Issued in CA

Practice address

1441 Florida Ave
Modesto, CA 95350-4405

Phone

(209) 576-3525

Fax

(209) 576-3544

NPI assigned

Nov 30, 2006

Last updated

Jul 8, 2007By 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 CA

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

Internal Medicine

Education

University of Southern California Keck School of Medicine, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hospitalists of Modesto Medical Group IncGroup PAC ID 2567360027, 87 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Doctors Hospital of Manteca Hospital, Manteca, CA, CCN 050118
• Doctors Medical Center Hospital, Modesto, CA, CCN 050464
• Emanuel Medical Center Hospital, Turlock, CA, CCN 050179

Merit-based Incentive Payment System (MIPS)

Final score

90.24 of 100Reported as individual

Quality

100

Improvement activities

0

Cost

84.14

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Hospitalists of Modesto Medical Group Inc

  • Internal Medicine Physician
  • Modesto, CA
  • NPI 1821190711
  Medicare reassignment Care Compare group NPD Authorized official
• First Choice Physician Partners

  dba Greater Modesto Medical Surgical Associates

  • Neurological Surgery Physician
  • Modesto, CA
  • NPI 1104183052
  Medicare reassignment NPD
• First Choice Physician Partners

  dba De La Pena Eye Clinic, A Medical Group

  • Ophthalmology Physician
  • El Monte, CA
  • NPI 1912732892
  NPD
• Doctors Medical Center of Modesto, Inc.

  dba Doctors Medical Center of Modesto

  • General Acute Care Hospital
  • Modesto, CA
  • NPI 1184654923
  NPD (past)
• Sutter Valley Hospitals

  dba Memorial Medical Center

  • General Acute Care Hospital
  • Modesto, CA
  • NPI 1699129601
  NPD (past)

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

• Doctors Hospital of Manteca, Inc.

  dba Doctors Hospital of Manteca

  • General Acute Care Hospital
  • Manteca, CA
  • NPI 1992736599
  Care Compare affiliation
• Doctors Medical Center of Modesto, Inc.

  dba Doctors Medical Center of Modesto

  • General Acute Care Hospital
  • Modesto, CA
  • NPI 1184654923
  Care Compare affiliation
• Doctors Medical Center of Modesto, Inc.

  dba Emanuel Medical Center

  • General Acute Care Hospital
  • Turlock, CA
  • NPI 1396087672
  Care Compare affiliation

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679641666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 FLORIDA AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504405",
            "telephone_number": "209-576-3525",
            "fax_number": "209-576-3544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 FLORIDA AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504405",
            "telephone_number": "209-576-3525",
            "fax_number": "209-576-3544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "THOMAS",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "CA",
            "license": "G42269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marissa Brooke Wall, OD
• John Wallace
• Kevin Wallace
• Kevin Wallace, ND
• Sasha Wallace
• Monica Walle
• Ruby Laura Walls
• Walmart Inc. (WalMart Pharmacy 10-5710)
• Walmart Inc. (Walmart Pharmacy 10-1587)
• Walmart Inc. (WalMart Pharmacy 10-3046)

• Critical Care Medicine (Internal Medicine) Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Critical Care Medicine (Internal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.