Jessica Danielle Wallace, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

TL.0009795 Issued in CO

Practice address

3055 Roslyn St Unit 100
Denver, CO 80238-3324

Phone

(720) 553-2696

NPI assigned

Apr 27, 2023

Last updated

Apr 27, 2023By the provider in NPPES

Sex

Female

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 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 Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: jwallace263728@direct.childrenscolorado.org

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.

• Children's Hospital Colorado

  • Clinical Social Worker
  • Aurora, CO
  • NPI 1174282776
  NPD

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

{
    "created_epoch": "1682553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682553600000",
    "number": "1740978824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3055 ROSLYN ST UNIT 100",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802383324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 ROSLYN ST UNIT 100",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802383324",
            "telephone_number": "720-553-2696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JESSICA",
        "middle_name": "DANIELLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-27",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": "TL.0009795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Wallace, M.D.
• Ann Shirley Wallace
• Brandy Dawn Wallace
• Gerald F Wallace, DDS
• Graham Wilson Wallace, MD
• Julie Gilman Wallace, P.T.
• Karrina Wallace, ND
• Madison Wallace
• Nicole Marie Wallace, PH.D.
• Stephen Blake Wallace, MD

• Student in an Organized Health Care Education/Training Program in Denver, CO
• Providers in Denver, CO by specialty
• Student in an Organized Health Care Education/Training Program in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 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.