Temeka Wallace, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

001006945 Issued in NC

Practice address

800 Susan Tart Rd
Dunn, NC 28334-5506

Phone

(910) 892-8892

Fax

(910) 892-1063

NPI assigned

Jan 18, 2017

Last updated

Jan 18, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carter Clinic, P aGroup PAC ID 1254429921, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carter Clinic, P a

  • Psychiatry Physician
  • Raleigh, NC
  • NPI 1912959834

  Medical

  Medicare reassignment Care Compare group NPD
• Carter Clinic, P.a.

  • Psychiatry Physician
  • Wilson, NC
  • NPI 1588211049
  NPD

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

{
    "created_epoch": "1484697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484697600000",
    "number": "1700322468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SUSAN TART RD",
            "city": "DUNN",
            "state": "NC",
            "postal_code": "283345506",
            "telephone_number": "910-892-8892",
            "fax_number": "910-892-1063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SUSAN TART RD",
            "city": "DUNN",
            "state": "NC",
            "postal_code": "283345506",
            "telephone_number": "910-892-8892",
            "fax_number": "910-892-1063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TEMEKA",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-18",
        "last_updated": "2017-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "001006945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Rite Aid)
• Walgreen Co (Walgreens #12895)
• Walgreens Pharmacy
• Walk by Faith Adult Health & Day Care LLC
• Shanley Walker
• Bruce Arnold Ward, PA-C
• Warren Eye Care Optometry PA
• Hubert Holman Warren Jr., OD
• Michelle Christina Warren, MD, MSPH
• Russell Alan Warren, OD

• Medical Physician Assistant in Dunn, NC
• Providers in Dunn, NC by specialty
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; 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.