Vicki Jo Wallis, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

22626 Issued in AL

Practice address

829 Riverbend Dr
Gadsden, AL 35901-2556

Phone

(256) 546-4611

Fax

(256) 546-2214

NPI assigned

May 10, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

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

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 and National Provider Directory roles.

• Children'S Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Birmingham, AL
  • NPI 1124541438

  AL, Pediatrics

  Medicare reassignment NPD
• Northeast Alabama Pediatrics, P.C.

  • Pediatrics Physician
  • Gadsden, AL
  • NPI 1306946546

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370390400000",
    "number": "1689623142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "829 RIVERBEND DR",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359012556",
            "telephone_number": "256-546-4611",
            "fax_number": "256-546-2214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 RIVERBEND DR",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359012556",
            "telephone_number": "256-546-4611",
            "fax_number": "256-546-2214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "VICKI",
        "middle_name": "JO",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2013-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "22626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114331",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lewis Patterson Walker III, MD
• Lacey Renee Wall, OTR
• James N Wallace, MD
• Spencer Riley Wallace, CRNP
• Jamie Waller
• Anastasia Walloga, DO
• Anderson Jay Ward III, CCP
• Kristina Marie Warren, CRNP
• Ricky Joe Warren, CRNA
• Linda Watson, LPN

• All providers in Gadsden, AL
• Pediatrics Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.