Active NPI
Matthew Edwin Wallace, ATC, PES
- Athletic Trainer
- Omaha, NE
National Provider Identifier
1760426258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 378
- Practice address
- Creighton Uniuversity
2500 California Plaza
Omaha, NE 68178-0001 - Phone
- (402) 280-5563
- Fax
- (402) 280-3110
- NPI assigned
- Jun 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 378 | NE | Primary |
Addresses
Primary practice location
Creighton Uniuversity
2500 California Plaza
Omaha, NE 68178-0001
Mailing address
2932 S 93Rd PLZ
Apt. 5
Omaha, NE 68124-2823
Phone (402) 990-4004
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 378 | NE | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1760426258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2932 S 93RD PLZ",
"address_2": "APT. 5",
"city": "OMAHA",
"state": "NE",
"postal_code": "681242823",
"telephone_number": "402-990-4004",
"fax_number": "402-280-3110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CREIGHTON UNIUVERSITY",
"address_2": "2500 CALIFORNIA PLAZA",
"city": "OMAHA",
"state": "NE",
"postal_code": "681780001",
"telephone_number": "402-280-5563",
"fax_number": "402-280-3110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "MATTHEW",
"middle_name": "EDWIN",
"name_prefix": "Mr.",
"credential": "ATC, PES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-15",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NE",
"license": "378",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.