Robert Wallace, PA, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

19738 Issued in CA

Practice address

747 52ND St
Oakland, CA 94609-1809

Phone

(510) 428-3022

Fax

(510) 428-3022

NPI assigned

Nov 3, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, 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 and National Provider Directory roles.

• Regents of the University of California

  • Internal Medicine Physician
  • San Francisco, CA
  • NPI 1760552343
  Medicare reassignment NPD
• UCSF Dept of Surgery

  • Surgery Physician
  • San Francisco, CA
  • NPI 1477627537
  Medicare reassignment NPD
• UCSF Medical Group Business Services

  • Internal Medicine Physician
  • San Francisco, CA
  • NPI 1477624104
  Medicare reassignment NPD
• UCSF Pediatrics Associates

  • Pediatrics Physician
  • San Francisco, CA
  • NPI 1376614016
  Medicare reassignment NPD
• University of California San Francisco

  • Pediatrics Physician
  • San Francisco, CA
  • NPI 1861578973
  Medicare reassignment NPD
• UCSF Medical Group Business Services

  • Health Service Clinic/Center
  • San Francisco, CA
  • NPI 1194115246
  NPD
• University of California San Francisco

  • Internal Medicine Physician
  • San Francisco, CA
  • NPI 1164512851
  NPD
• University of California San Francisco

  • Community/Retail Pharmacy
  • San Francisco, CA
  • NPI 1659141711
  NPD
• Regents of the University of California

  • Rheumatology Physician
  • San Francisco, CA
  • NPI 1881763597
  NPD (past)
• University of California San Francisco

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • San Francisco, CA
  • NPI 1992818256
  NPD (past)

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

{
    "created_epoch": "1257206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339372800000",
    "number": "1720315336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "747 52ND ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946091809",
            "telephone_number": "510-238-0121",
            "fax_number": "510-238-0121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "747 52ND ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946091809",
            "telephone_number": "510-428-3022",
            "fax_number": "510-428-3022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ROBERT",
        "credential": "PA, NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-03",
        "last_updated": "2012-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA20650",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "19738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dierdre Wallace
• Jacob Wallace II
• Janae Courtney Wallace, LVN
• Karis Michelle Wallace
• Katherine Lucas Wallace
• Sharmila Raevette Wallace, BA
• Thomas W Wallace, M.D.
• Stephen Lamare Waller
• Virgil Waller
• Celeste Ruth Walley

• Family Nurse Practitioner in Oakland, CA
• Providers in Oakland, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.