Jerald Payden Wallace, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

49437 Issued in KY

Practice address

800 Rose St
C246
Lexington, KY 40536-0293

Phone

(859) 323-6162

NPI assigned

May 21, 2014

Last updated

Jul 7, 2016By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

University of Alabama School of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

West Alabama Physician Associates LLCGroup PAC ID 3476620311, 36 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• DCH Regional Medical Center Hospital, Tuscaloosa, AL, CCN 010092

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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

• West Alabama Physician Associates, LLC

  dba West Alabama Urology Associates

  • Urology Physician
  • Tuscaloosa, AL
  • NPI 1316101769
  Medicare reassignment Care Compare group NPD
• The DCH Healthcare Authority

  dba DCH Regional Medical Center

  • General Acute Care Hospital
  • Tuscaloosa, AL
  • NPI 1841394418
  Medicare reassignment NPD
• The DCH Health Care Authority

  dba DCH Health & Wellness Clinic

  • Clinic/Center
  • Tuscaloosa, AL
  • NPI 1306613211
  NPD
• West Alabama Physician Associates, LLC

  dba West Alabama Surgical Associates

  • Surgery Physician
  • Tuscaloosa, AL
  • NPI 1518669431
  NPD
• West Alabama Physician Associates, LLC

  dba SouthEastern Spine

  • Orthopaedic Surgery of the Spine Physician
  • Tuscaloosa, AL
  • NPI 1861377970
  NPD
• West Alabama Physician Associates LLC

  dba West Alabama Vascular & Endovascular Surgery

  • Vascular Surgery Physician
  • Tuscaloosa, AL
  • NPI 1639877491
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The DCH Health Care Authority

  dba DCH Health & Wellness Clinic

  • Clinic/Center
  • Tuscaloosa, AL
  • NPI 1306613211

  Hospital

  Care Compare affiliation
• The DCH Health Care Authority

  dba DCH Outpatient Services

  • Clinic/Center
  • Tuscaloosa, AL
  • NPI 1780927681

  Hospital

  Care Compare affiliation
• The DCH Healthcare Authority

  dba DCH Regional Medical Center

  • General Acute Care Hospital
  • Tuscaloosa, AL
  • NPI 1841394418
  Care Compare affiliation

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

{
    "created_epoch": "1400630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467849600000",
    "number": "1730591017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 ROSE ST",
            "address_2": "C246",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405360293",
            "telephone_number": "859-323-6162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 ROSE ST",
            "address_2": "C246",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405360293",
            "telephone_number": "859-323-6162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JERALD",
        "middle_name": "PAYDEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-21",
        "last_updated": "2016-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KY",
            "license": "49437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy M Wallace, APRN, NNP-BC
• Ato Wallace, MD
• Carmel Wallace Jr., MD
• Chelsea Cernosek Wallace, M.D.
• Derrick Paul Wallace
• 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

• Surgery Physician in Lexington, KY
• Providers in Lexington, KY by specialty
• Surgery Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2016; 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.