Phyllis Marie Wallace, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

AP117949 Issued in TX

Practice address

6560 Fannin St
Suite 600
Houston, TX 77030-2761

Phone

(713) 796-0500

NPI assigned

May 21, 2009

Sex

Female

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 TX

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mint Anesthesia, PLLCGroup PAC ID 3072828342, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/AAEABA
• FHIR API: https://api.platform.athenahealth.com/27020/brand/1/csg/1/fhir/r4

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.

• Mint Anesthesia, PLLC

  • Anesthesiology Physician
  • Conroe, TX
  • NPI 1790172187
  Medicare reassignment Care Compare group NPD
• Bayou Anesthesia and Pain P.a.

  • Anesthesiology Physician
  • Houston, TX
  • NPI 1114977139
  Medicare reassignment NPD
• Endo Sedation LLC

  • Certified Registered Nurse Anesthetist
  • Keller, TX
  • NPI 1588931174

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Epix Medical Services of Houston PLLC

  • Certified Registered Nurse Anesthetist
  • Houston, TX
  • NPI 1417392200

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Lakeside Gastroenterology and Liver Specialists, PLLC

  • Gastroenterology Physician
  • Conroe, TX
  • NPI 1033439781
  Medicare reassignment NPD
• Northwest Anesthesiology & Pain Services, P.a.

  • Anesthesiology Physician
  • Houston, TX
  • NPI 1629027511
  Medicare reassignment NPD
• Endo Sedation LLC

  • Certified Registered Nurse Anesthetist
  • Flower Mound, TX
  • NPI 1114270931

  Nurse Anesthetist, Certified Registered

  NPD
• Endo Sedation LLC

  • Certified Registered Nurse Anesthetist
  • Beaumont, TX
  • NPI 1548817471

  Nurse Anesthetist, Certified Registered

  NPD

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

{
    "created_epoch": "1242864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435017600000",
    "number": "1679708556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 E. SHERWOOD DR.",
            "city": "ALVIN",
            "state": "TX",
            "postal_code": "77511",
            "telephone_number": "832-621-6220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6560 FANNIN ST",
            "address_2": "SUITE 600",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302761",
            "telephone_number": "713-796-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "PHYLLIS",
        "middle_name": "MARIE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-21",
        "last_updated": "2015-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "561885",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "AP117949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marcy Marie Wallace, LSSP, PA
• Maria Annette Wallace
• Maureen Kay Wallace, RNFA
• Nyesha Wallace
• Pamela Lindsey Wallace, PT, DPT
• Rebecca Ann Wallace, MSW
• Rebekah Wallace, LCSW
• Shannon E Wallace
• Sharon Renee Wallace, MD
• Shawnee Wallace, DO

• Certified Registered Nurse Anesthetist in Houston, TX
• Providers in Houston, TX by specialty
• Certified Registered Nurse Anesthetist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.