Christina Blair Wallace, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

T-3899 Issued in MS

Practice address

2500 N State St
Jackson, MS 39216-4500

Phone

(601) 984-5601

Fax

(601) 984-6665

NPI assigned

Apr 3, 2019

Sex

Female

Sole proprietor

No

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.

• Mississippi Band of Choctaw Indians

  • General Acute Care Hospital
  • Choctaw, MS
  • NPI 1790865780

  TX

  Medicare reassignment Care Compare group NPD
• Mississippi Band of Choctaw Indians

  • Ambulance
  • Choctaw, MS
  • NPI 1548358153
  Care Compare group NPD
• Mississippi Band of Choctaw Indians

  • Nursing Facility/Intermediate Care Facility
  • Choctaw, MS
  • NPI 1154379469
  Care Compare group
• Mississippi Band of Choctaw Indians

  • Federal Public Health Clinic/Center
  • Choctaw, MS
  • NPI 1255533758
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sta-Home Health Agency of Carthage, Inc

  • Home Health Agency
  • Carthage, MS
  • NPI 1275674533
  Care Compare affiliation

Specialty

Family Practice

Education

University of Mississippi School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mississippi Band of Choctaw Indians 23 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Accentcare Home Health of Carthage Home health agency, Carthage, MS, CCN 257129
• Choctaw Health Center Hospital, Philadelphia, MS, CCN 250127

Medicare fee-for-service enrollment

Enrolled in TX

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

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 5, 2019.

{
    "created_epoch": "1554249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562284800000",
    "number": "1760944284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-5601",
            "fax_number": "601-984-6665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-5601",
            "fax_number": "601-984-6665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CHRISTINA",
        "middle_name": "BLAIR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-03",
        "last_updated": "2019-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "T-3899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tenelle Elaine Walker
• Thomas Atchley Walker, M.D.
• Wendy Collier Walker, LCSW
• Marcus D Walkinshaw, MD
• Amy Wall
• Erin E Wallace
• Gary Robert Wallace, PTA
• Quentin Wallace
• William David Wallace, MD
• William H. Wallace

• All providers in Jackson, MS
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.