NPIMap

Individual provider Active NPI

Amy Hooks Wallace, M.D.

  • Gynecologic Oncology Physician
  • Winston Salem, NC
National Provider Identifier
1740457209
Registry record updated May 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
License
2012-00695 Issued in NC
Practice address
3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone
(336) 277-8800
Fax
(336) 277-8850
NPI assigned
May 14, 2008
Last updated
May 12, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology Physician 207VX0201X 2012-00695 NC Primary

Addresses

Primary practice location

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013

Mailing address

PO Box 75216
Charlotte, NC 28275-0216
Phone (336) 277-8800

Other practice location 1

1010 Bethesda Ct
Winston Salem, NC 27103-3019
Phone (336) 277-8800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address awallace188860@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121020000054 NC Practitioner - Gynecological OncologyPractitioner - Obstetrics/Gynecology 1951551365 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gynecological OncologyAlso: Obstetrics/Gynecology
Education
Wake Forest University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1213 Lexington Ave
Suite B
Thomasville, NC 27360-3416
Phone (336) 481-1950

276 Old Mocksville Rd
Suite 800
Statesville, NC 28625-1952
Phone (704) 873-5150

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of the uterus1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Thomasville Medical Center, LLC CurrentSince Mar 1, 2022 Accepting new patients
Novant Health Rowan Medical Center, LLC CurrentSince Mar 1, 2022 Accepting new patients
Forsyth Memorial Hospital, Inc. Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Jan 1, 2016 Accepting new patients
Forsyth Memorial Hospital Inc CurrentSince Sep 1, 2014 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Jan 1, 2016 Accepting new patients
Novant Health Rowan Medical Center, LLC CurrentSince Mar 1, 2022 Accepting new patients
Novant Health Rowan Medical Center LLC Current Accepting new patients
Novant Health Thomasville Medical Center LLC CurrentSince Mar 1, 2022 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Sep 1, 2014 Accepting new patients
Novant Health Thomasville Medical Center LLC Past Accepting new patients

Locations

1918 Randolph Rd
Ste 175
Charlotte, NC 28207
Phone (704) 316-1050

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

1710 Kernersville Medical Pkwy
Ste 116
Kernersville, NC 27284
Phone (336) 564-4170

1919 W Park Dr
North Wilkesboro, NC 28659
Phone (336) 651-2980

612 Mocksville Ave
Salisbury, NC 28144
Phone (704) 210-5000

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

276 Old Mocksville Rd
Ste 800
Statesville, NC 28625
Phone (704) 873-5150

1213 Lexington Ave
#B
Thomasville, NC 27360
Phone (336) 249-6632

207 Old Lexington Rd
Thomasville, NC 27360
Phone (336) 472-2000

1010 Bethesda Ct
Winston Salem, NC 27103
Phone (336) 277-6000

175 Kimel Park Dr
Winston Salem, NC 27103
Phone (336) 718-1006

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

Interoperability endpoints

  • Direct secure messaging: awallace188860@direct.novanthealth.org

Organizations & group practices 12

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.

Hospital & facility affiliations 4

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": "1210723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652313600000",
    "number": "1740457209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 75216",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282750216",
            "telephone_number": "336-277-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 SILAS CREEK PKWY",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033013",
            "telephone_number": "336-277-8800",
            "fax_number": "336-277-8850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 Bethesda Ct",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271033019",
            "country_code": "US",
            "telephone_number": "336-277-8800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "AMY",
        "middle_name": "HOOKS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-14",
        "last_updated": "2022-05-12",
        "certification_date": "2021-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "NC",
            "license": "2012-00695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awallace188860@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1010 Bethesda Ct",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271033019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.