NPIMap

Individual provider Active NPI

Wallace Alvin Donaldson, M.D.

  • General Practice Physician
  • Zillah, WA
National Provider Identifier
1750355020
Registry record updated Jan 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
MD00009019 Issued in WA
Practice address
102 6TH St
Zillah, WA 98953-9442
Phone
(509) 829-5699
Fax
(509) 829-6366
NPI assigned
Feb 14, 2006
Last updated
Jan 3, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 3, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X MD00009019 WA Primary

Addresses

Primary practice location

102 6TH St
Zillah, WA 98953-9442

Mailing address

102 6TH St
Zillah, WA 98953-9442
Phone (509) 829-5699

Other identifiers 1

IdentifierTypeStateIssuer
1531508MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00009019WAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
BD Monroe I LLC Past Accepting new patients
Garden Village Past Accepting new patients
BD Yakima I, LLC Past Accepting new patients
Crescent Convalescent Center Past Accepting new patients
Forefront-Rosenzweig Medical Services Professional Corporation Past Accepting new patients
Crescent Health Care, Inc. Past Accepting new patients

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325548800000",
    "number": "1750355020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 6TH ST",
            "city": "ZILLAH",
            "state": "WA",
            "postal_code": "989539442",
            "telephone_number": "509-829-5699",
            "fax_number": "509-829-6366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 6TH ST",
            "city": "ZILLAH",
            "state": "WA",
            "postal_code": "989539442",
            "telephone_number": "509-829-5699",
            "fax_number": "509-829-6366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONALDSON",
        "first_name": "WALLACE",
        "middle_name": "ALVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2012-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WA",
            "license": "MD00009019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1531508",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Zillah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.