Thomas Everett Wallace, M.D.

Primary specialty

Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X

License

43982 Issued in KY

Practice address

740 S Limestone
L543, Kentucky Clinic
Lexington, KY 40536-0284

Phone

(859) 323-5045

Fax

(859) 257-2418

NPI assigned

Jun 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Other identifiers 7

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. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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.

• Deaconess Hospital, Inc

  • Hospitalist Physician
  • Evansville, IN
  • NPI 1427097443

  Internal Medicine

  NPD
• Select Specialty Hospital - Evansville LLC

  • Long Term Care Hospital
  • Evansville, IN
  • NPI 1750380739
  NPD
• South Tulsa Medical Group LLC

  • Internal Medicine Physician
  • Tulsa, OK
  • NPI 1518998483
  NPD (past)
• Southeastern Intensivist Services PC

  • Hospitalist Physician
  • West Memphis, AR
  • NPI 1912942665

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1700822822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 S LIMESTONE",
            "address_2": "L534, KENTUCKY CLNIC",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405360284",
            "telephone_number": "859-323-5045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 S LIMESTONE",
            "address_2": "L543, KENTUCKY CLINIC",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405360284",
            "telephone_number": "859-323-5045",
            "fax_number": "859-257-2418"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4015 Gateway Blvd",
            "address_purpose": "LOCATION",
            "city": "Newburgh",
            "state": "IN",
            "postal_code": "476308925",
            "country_code": "US",
            "telephone_number": "812-450-7720",
            "fax_number": "812-450-7730",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "519 Harriet St",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477101715",
            "country_code": "US",
            "telephone_number": "812-450-7720",
            "fax_number": "812-450-7730",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "327 Medical Park Dr",
            "address_purpose": "LOCATION",
            "city": "Bridgeport",
            "state": "WV",
            "postal_code": "263309006",
            "country_code": "US",
            "telephone_number": "681-342-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "THOMAS",
        "middle_name": "EVERETT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "TN",
            "license": "MD23936",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "WV",
            "license": "30857",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "KY",
            "license": "43982",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "KY",
            "license": "43982",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "43982",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "WV",
            "license": "30857",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33270961",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TENNESSEE",
            "identifier": "4123936",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "4158379",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201256750",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00317082",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3327097",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30707611",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Bourne Wallace, M.A., CCC/SLP
• Kellie L Wallace, RN, MSN
• Madison Wallace, LPCC
• Matthew Richard Wallace, DNP, APRN, PMHNP-BC
• Patricia Sue Wallace, APRN
• William Robert Wallace, M.D.
• Joyce Anne Wallen, M.ED.
• Shawna Wallen, RPH
• Peter M Wallenhorst, M.D.
• Waller and Davis Radiology

• Critical Care Medicine (Internal Medicine) Physician in Lexington, KY
• Providers in Lexington, KY by specialty
• Critical Care Medicine (Internal Medicine) Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; 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.