Bethany Ann Wallace, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

27638 Issued in CO

Practice address

8890 N Union Blvd Ste 170
Colorado Springs, CO 80920-2701

Phone

(719) 365-6421

Fax

(719) 365-6408

NPI assigned

Sep 27, 2006

Sex

Female

Sole proprietor

Yes

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 CO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Colorado Urgent Care Physicians, PC

  • Urgent Care Clinic/Center
  • Englewood, CO
  • NPI 1245514355
  NPD
• Colorado Urgent Care Physicians, PC

  • Clinic/Center
  • Englewood, CO
  • NPI 1306339163
  NPD
• Clinix Health Services of Colorado Inc

  • Family Medicine Physician
  • Centennial, CO
  • NPI 1912011073
  NPD (past)

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684022400000",
    "number": "1740371699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "558 E CASTLE PINES PKWY PMB 151",
            "city": "CASTLE ROCK",
            "state": "CO",
            "postal_code": "801084608",
            "telephone_number": "719-365-6421",
            "fax_number": "710-365-6408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8890 N UNION BLVD STE 170",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809202701",
            "telephone_number": "719-365-6421",
            "fax_number": "719-365-6408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BETHANY",
        "middle_name": "ANN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2023-05-14",
        "certification_date": "2023-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "27638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy K Wall, NP
• Jillyn Wall, LMT
• Richard Allen Wall, M.D.
• Walla Investment LLC
• Ashli Keanan Wallace
• Bradley Wallace, M.D.
• Camille N Wallace, OTD, OTR/L
• Emily Anne Wallace, RBT
• Emma Wallace
• Erik Allen Wallace, MD

• Family Medicine Physician in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2023; 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.