Jordan Scott Wallace, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD61570069 Issued in WA

Practice address

9801 Frontier Ave SE
Snoqualmie, WA 98065-5200

Phone

(425) 831-2300

NPI assigned

Mar 22, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Practice roles

Locations

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.

• Public Hospital District No 4 King County Washington

  • Critical Access Hospital
  • Snoqualmie, WA
  • NPI 1902846546
  Medicare reassignment NPD
• Public Hospital District No 4 King County Washington

  • Rural Health Clinic/Center
  • Snoqualmie, WA
  • NPI 1558869289
  NPD
• Public Hospital District No 4, King County Wa

  • Family Medicine Physician
  • Snoqualmie, WA
  • NPI 1144432634

  Pediatrics

  NPD
• Public Hospital District No 4 King County Washington

  • Rural Health Clinic/Center
  • Snoqualmie, WA
  • NPI 1194237131
  NPD (past)

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

{
    "created_epoch": "1584835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760486400000",
    "number": "1780210658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9801 FRONTIER AVE SE",
            "city": "SNOQUALMIE",
            "state": "WA",
            "postal_code": "980655200",
            "telephone_number": "425-831-2300",
            "fax_number": "425-396-7694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9801 FRONTIER AVE SE",
            "city": "SNOQUALMIE",
            "state": "WA",
            "postal_code": "980655200",
            "telephone_number": "425-831-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JORDAN",
        "middle_name": "SCOTT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-22",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD61570069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Britney Varhley, M.S. SLP-CCC
• H. Martin Vatheuer, MD
• Liane M Venezia, RN
• Elizabeth Ann Koenig Viney, PHD
• Anna Helena Wahlstrom, CDP
• Jennifer Gloria Walsh, CCC-SLP
• Michelle Marie Walter, ND
• Melissa Rose Walters, PSYD
• Courtney Ann Warren, LMHC, MHP
• Demi Watts, RN

• Pediatrics Physician in Snoqualmie, WA
• Providers in Snoqualmie, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.