Jennifer L Wallace, M D

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

H9277 Issued in TX

Practice address

7720 Jones Maltsberger
Suite 110
San Antonio, TX 78216

Phone

(210) 822-2004

Fax

(210) 822-2215

NPI assigned

Sep 13, 2005

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 4

Medicare fee-for-service enrollment

Enrolled in TX

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 Texas Medical School at San Antonio, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Execudoc, IncGroup PAC ID 6305822438, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Medical Center Hospital, San Antonio, TX, CCN 450058

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.

• Execudoc, Inc

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1730386905
  Medicare reassignment Care Compare group NPD
• San Antonio Internal Medicine Group PA

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1346369253
  NPD

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

• VHS San Antonio Partners LLC

  • General Acute Care Hospital
  • San Antonio, TX
  • NPI 1598744856
  Care Compare affiliation

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461628800000",
    "number": "1699760934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7720 JONES MALTSBERGER",
            "address_2": "SUITE 110",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78216",
            "telephone_number": "210-822-2004",
            "fax_number": "210-822-2215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7720 JONES MALTSBERGER",
            "address_2": "SUITE 110",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78216",
            "telephone_number": "210-822-2004",
            "fax_number": "210-822-2215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-13",
        "last_updated": "2016-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "H9277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117537404",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117537405",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135685902",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "8DL467",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Derek James Wallace
• Diane P. Wallace, OTR
• Gloria T Wallace
• Jandale Wallace
• Jaynel Lynn Wallace
• Jesse Bryan Wallace, D.C.
• John Wallace
• Kathryn Wallace
• Kimberly Louise Wallace, RN
• Maria Guadalupe Wallace, NP

• Internal Medicine Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2016; 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.