NPIMap

Individual provider Active NPI

Gregory L. Wallace, MD

  • Anesthesiology Physician
  • Laramie, WY
National Provider Identifier
1770712309
Registry record updated Jul 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
9296A Issued in WY
Practice address
204 McCollum Dr
Suite 101
Laramie, WY 82070-5151
Phone
(307) 745-6065
Fax
(307) 745-4936
NPI assigned
Jul 2, 2009
Last updated
Jul 1, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Anesthesiology Physician 207L00000X 9296A WY Primary

Addresses

Primary practice location

204 McCollum Dr
Suite 101
Laramie, WY 82070-5151

Mailing address

204 McCollum Dr
Suite 101
Laramie, WY 82070-5151
Phone (307) 745-6065

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130813000496 WY Practitioner - Anesthesiology 3971745464 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Washington School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Associates of Laramie LLCGroup PAC ID 8123001500, 3 clinicians

Practice addresses (Care Compare)

255 N 30TH St
Laramie, WY 82072-5140
Phone (307) 742-2141

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
33.71 of 100Reported as group
Quality
39.66
Improvement activities
0

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9296AWYMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Associates of Laramie LLC Anesthesiology CurrentSince Jul 8, 2013 Accepting new patients
High Plains General Surgery Inc Past Accepting new patients

Locations

1909 Vista Dr
Laramie, WY 82070
Phone (307) 721-8024

204 McCullum Dr
Ste 101
Laramie, WY 82070
Phone (307) 745-6065

255 N 30th St
Laramie, WY 82072
Phone (307) 742-2141

Organizations & group practices 2

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1246492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372636800000",
    "number": "1770712309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 MCCOLLUM DR",
            "address_2": "SUITE 101",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820705151",
            "telephone_number": "307-745-6065",
            "fax_number": "307-745-4936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 MCCOLLUM DR",
            "address_2": "SUITE 101",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820705151",
            "telephone_number": "307-745-6065",
            "fax_number": "307-745-4936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "GREGORY",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-02",
        "last_updated": "2013-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WY",
            "license": "9296A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laramie, WY

Sources for this page

Verify at the official NPI Registry.