John D Wallace

Primary specialty

HomemakerTaxonomy code 376J00000X

License

235276 Issued in FL

Practice address

1455 NW 53Rd St Apt 222
Miami, FL 33142

Phone

(904) 418-3893

NPI assigned

Sep 30, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1380499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530230400000",
    "number": "1679900161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15286 SW 104TH ST APT 2-22",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331963238",
            "telephone_number": "904-418-3893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 NW 53RD ST APT 222",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33142",
            "telephone_number": "904-418-3893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JOHN",
        "middle_name": "D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-09-30",
        "last_updated": "2018-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "FL",
            "license": "235276",
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Homemaker",
            "state": "FL",
            "license": "235276",
            "primary": true
        },
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": "FL",
            "license": "235276",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine Elena Walkington, M.D., M.B.A.
• Erin Wall, PA-C
• De'Ja Wallace
• Douglas McKay Wallace, MD
• Ja'Mese B Wallace, DPM
• Ryan Todd Wallace, MD
• Zehava Tamar Wallace, LCSW
• Howard William Wallach, M.D.
• Melissa Wallen, ARNP
• Graciela Waller

• Homemaker in Miami, FL
• Providers in Miami, FL by specialty
• Homemaker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.