Active NPI
Bailey J Wallace
- Social Worker
- Indianapolis, IN
National Provider Identifier
1770276552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 33010358A
- Practice address
- 1040 Wishard Blvd
Indianapolis, IN 46202-2872 - Phone
- (317) 962-8893
- NPI assigned
- May 30, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S.2208499 | OH | |
| Social Worker | 104100000X | 33010358A | IN | Primary |
Addresses
Primary practice location
1040 Wishard Blvd
Indianapolis, IN 46202-2872
Mailing address
3434 Hollansburg Sampson Rd
Greenville, OH 45331-9721
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 |
|---|---|---|---|
| 33010358A | IN | MD | Social Worker |
| S.2208499 | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685404800000",
"number": "1770276552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3434 HOLLANSBURG SAMPSON RD",
"city": "GREENVILLE",
"state": "OH",
"postal_code": "453319721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1040 WISHARD BLVD",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462022872",
"telephone_number": "317-962-8893"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "BAILEY",
"middle_name": "J",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-05-30",
"last_updated": "2023-05-30",
"certification_date": "2023-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.2208499",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IN",
"license": "33010358A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.