NPIMap

Individual provider Active NPI

Michael D Wallisch, MD

  • Diagnostic Radiology Physician
  • Carlisle, PA
National Provider Identifier
1760420632
Registry record updated Apr 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD033581E Issued in PA
Practice address
850 Walnut Bottom Rd
Carlisle, PA 17013-3632
Phone
(814) 643-6207
Fax
(814) 643-6165
NPI assigned
Jun 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD033581E PA Primary

Addresses

Primary practice location

850 Walnut Bottom Rd
Carlisle, PA 17013-3632

Mailing address

900 Bryan St
Suite 2
Huntingdon, PA 16652-2413
Phone (814) 643-6207

Other identifiers 2

IdentifierTypeStateIssuer
0010634900001MedicaidPA
MD033581EOtherPALICENSE

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
MD033581EPAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cardiology Diagnostic Associates, LLC Past Accepting new patients
Cumberland Pathology Associates, LLC Past Accepting new patients
Ephrata Radiologic Associates LTD Diagnostic Radiology Past Accepting new patients
Imaging Associates of Greater Pittsburgh Diagnostic Radiology Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207872000000",
    "number": "1760420632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 BRYAN ST",
            "address_2": "SUITE 2",
            "city": "HUNTINGDON",
            "state": "PA",
            "postal_code": "166522413",
            "telephone_number": "814-643-6207",
            "fax_number": "814-643-6165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 WALNUT BOTTOM RD",
            "city": "CARLISLE",
            "state": "PA",
            "postal_code": "170133632",
            "telephone_number": "814-643-6207",
            "fax_number": "814-643-6165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLISCH",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2008-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD033581E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010634900001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "MD033581E",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carlisle, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; 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.