Ray L Wallace Jr., PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

000935 Issued in GA

Practice address

4425 Paulsen St
Savannah, GA 31405-3662

Phone

(912) 355-6615

Fax

(912) 351-0645

NPI assigned

Jun 23, 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 2

Medicare fee-for-service enrollment

Enrolled in GA

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, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chatham Orthopaedic Associates PAGroup PAC ID 8022910306, 55 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

84 of 100Reported as group

Quality

65.06

Promoting interoperability

98

Improvement activities

40

Cost

83.28

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ray.wallace.1@18355.direct.athenahealth.com

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.

• Chatham Orthopaedic Associates, PA

  • Orthopaedic Surgery Physician
  • Savannah, GA
  • NPI 1366495814
  Medicare reassignment Care Compare group NPD (past)
• Effingham Orthopedic Practice, LLC

  dba Effingham Orthopaedic Center

  • Orthopaedic Surgery Physician
  • Rincon, GA
  • NPI 1013459551
  Medicare reassignment
• Chatham Orthopaedic Associates, PA

  • Orthopaedic Surgery Physician
  • Pooler, GA
  • NPI 1598153900
  NPD
• Chatham Orthopaedic Associates, PA

  dba Chatham Sports Medicine

  • Specialist
  • Savannah, GA
  • NPI 1710029137
  NPD
• Advanced Pediatric Specialists LLC

  • Pediatrics Physician
  • Savannah, GA
  • NPI 1073046397
  NPD (past)
• Optim Orthopedics, LLC

  dba Optim Orthopedics

  • Orthopaedic Surgery Physician
  • Midway, GA
  • NPI 1821639758
  NPD (past)
• Optim Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Bluffton, SC
  • NPI 1528451481
  NPD (past)

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1720014624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 PAULSEN ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314053662",
            "telephone_number": "912-355-6615",
            "fax_number": "912-351-0645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 PAULSEN ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314053662",
            "telephone_number": "912-355-6615",
            "fax_number": "912-351-0645"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 St Josephs Candler Dr Fl 1",
            "address_purpose": "LOCATION",
            "city": "Pooler",
            "state": "GA",
            "postal_code": "313229579",
            "country_code": "US",
            "telephone_number": "912-355-6615",
            "fax_number": "912-351-0645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "RAY",
        "middle_name": "L",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "000935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203066747B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203066747A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Austin William Wallace
• Claudia Nancy Wallace, LCSW
• Conchita Wallace
• Erika Wallace
• Heather Morgan Wallace, MD
• Synthia Joy-Best Wallace, LAPC
• Timothy Brian Wallace, MD
• William Fredrick Wallace, M.D.
• Debra Keefe Walland, MD
• Jason Lee Waller, PHARMD

• Physician Assistant in Savannah, GA
• Providers in Savannah, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; 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.