Tor Erik William Wallstrom, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25545 Issued in AZ

Practice address

1394 W 16TH St
Yuma, AZ 85364-4430

Phone

(928) 539-0055

Fax

(928) 539-0053

NPI assigned

Jul 14, 2006

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/11296/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.

• Northside Medical Clinic Walk in LLC

  • Urgent Care Clinic/Center
  • Yuma, AZ
  • NPI 1245226398
  NPD (past)
• Alliance Healthcare Services Inc

  • Mobile Radiology Clinic/Center
  • Elkton, MD
  • NPI 1437649068
  NPD (past)

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328832000000",
    "number": "1700802964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1394 W 16TH ST",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853644430",
            "telephone_number": "928-539-0055",
            "fax_number": "928-539-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1394 W 16TH ST",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853644430",
            "telephone_number": "928-539-0055",
            "fax_number": "928-539-0053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLSTROM",
        "first_name": "TOR ERIK",
        "middle_name": "WILLIAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2012-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "25545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "469024001",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Vananthony Walker
• Tiffany Walker, PMHNP-C
• Juliann Maria Wallace, RN
• Melissa Marie Wallace
• Stephen A Wallace, MD
• Walmart Inc. (Walmart Pharmacy 10-7320)
• Walmart Inc. (Walmart Pharmacy 10-1474)
• Walmart Inc. (Walmart Pharmacy 10-5342)
• Walmart Inc. (Walmart Pharmacy 10-4325)
• Walmart Stores, Inc. (Vision Center 30-5342)

• Family Medicine Physician in Yuma, AZ
• Providers in Yuma, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.