Individual provider Active NPI

Patrick Joseph Wallace, M.D.

  • Trauma Surgery Physician
  • League City, TX
National Provider Identifier
1740219369
Registry record updated Nov 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
License
J7243 Issued in TX
Practice address
2240 Gulf Fwy S Ste 2.100
League City, TX 77573-5143
Phone
(832) 505-1800
NPI assigned
Jul 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X J7243 TX
Surgical Oncology Physician 2086X0206X J7243 TX
Trauma Surgery Physician 2086S0127X J7243 TX Primary

Addresses

Primary practice location

2240 Gulf Fwy S Ste 2.100
League City, TX 77573-5143

Mailing address

2240 Gulf Fwy S Ste 2.100
League City, TX 77573-5143
Phone (832) 505-1800

Other identifiers 3

IdentifierTypeStateIssuer
8S4802OtherTXBLUE CROSS/BLUE SHIELD
P00229401OtherMEDICARE RAILROAD
041937602MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20050713000339 TX Practitioner - General Surgery 0941236715 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Chicago, Pritzker School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Utmb Faculty Group PracticeGroup PAC ID 3375456734, 1,083 clinicians

Practice addresses (Care Compare)

200 Blossom St
Webster, TX 77598-4204
Phone (832) 632-6500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.88 of 100Reported as group
Quality
73.38
Improvement activities
40
Cost
78.42

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
J7243TXMDTrauma Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Utmb Faculty Group Practice Surgery CurrentSince Jan 17, 2023 Accepting new patients
Harold M Selzman MD Facp PA PastSince Dec 30, 2007 Accepting new patients
University of Texas Medical Branch at Galveston Past Accepting new patients

Locations

301 University Blvd
Galveston, TX 77555
Phone (409) 747-1883

712 Texas Ave 2nd
Galveston, TX 77555

511 Park Grove Dr
Katy, TX 77450
Phone (281) 398-7001

2240 Gulf Fwy S
Ste 2110
League City, TX 77573
Phone (832) 505-1600

2240 Gulf Fwy S
Ste 2100
League City, TX 77573
Phone (832) 505-1600

250 Blossom St
Fl 4
Webster, TX 77598
Phone (409) 772-3695

200 Blossom St
Webster, TX 77598
Phone (281) 252-7000

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700524800000",
    "number": "1740219369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 GULF FWY S STE 2.100",
            "city": "LEAGUE CITY",
            "state": "TX",
            "postal_code": "775735143",
            "telephone_number": "832-505-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2240 GULF FWY S STE 2.100",
            "city": "LEAGUE CITY",
            "state": "TX",
            "postal_code": "775735143",
            "telephone_number": "832-505-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "PATRICK",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "J7243",
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "TX",
            "license": "J7243",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "TX",
            "license": "J7243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "8S4802",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00229401",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "041937602",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in League City, TX

Sources for this page

Verify at the official NPI Registry.