Charles W Wallace, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35080468W Issued in OH

Practice address

4455 Dressler Rd NW
Canton, OH 44718-2785

Phone

(330) 497-6555

Fax

(330) 497-3281

NPI assigned

Mar 8, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in GA, CA, MI, TX, MD, MN, IN, NC, LA, MS10 enrollments

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 10

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: charles.wallace.1@19957.direct.athenahealth.com

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.

• Allina Health System

  dba Allina Health Annandale Clinic

  • Family Medicine Physician
  • Annandale, MN
  • NPI 1457657249
  Medicare reassignment NPD
• Carolinas Physicians Network Inc

  dba Atrium Health Musculoskeletal Institute Orthopedics & Sports Medici

  • Orthopaedic Surgery Physician
  • Charlotte, NC
  • NPI 1437607686
  Medicare reassignment NPD
• Deaconess Specialty Physicians, Inc

  • Cardiovascular Disease Physician
  • Evansville, IN
  • NPI 1306344817
  Medicare reassignment NPD
• Ochsner Clinic LLC

  • General Practice Physician
  • New Orleans, LA
  • NPI 1538151428
  Medicare reassignment NPD
• Ochsner Mississippi, LLC

  • Internal Medicine Physician
  • Bay Saint Louis, MS
  • NPI 1538674239
  Medicare reassignment NPD
• Wellspan Medical Group

  dba Wellspan Family Medicine - Thurmont

  • Family Medicine Physician
  • Thurmont, MD
  • NPI 1881762995
  Medicare reassignment NPD
• Allina Health System

  dba Allina Health Farmington Clinic

  • Family Medicine Physician
  • Farmington, MN
  • NPI 1003112822
  NPD
• Allina Health System

  dba Allina Health TeleRheumatology

  • Rheumatology Physician
  • Coon Rapids, MN
  • NPI 1952146516
  NPD
• Carolinas Physicians Network Inc

  dba Atrium Health Diabetes Prevention

  • Endocrinology, Diabetes & Metabolism Physician
  • Charlotte, NC
  • NPI 1437038544
  NPD
• Carolinas Physicians Network, Inc

  dba Carolinas HealthCare System Virtual Visit

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1578939914
  NPD
• Centracare Clinic

  dba CentraCare - River Campus Clinic

  • Multi-Specialty Clinic/Center
  • Saint Cloud, MN
  • NPI 1043212665
  NPD
• Central Washington Health Services Association

  dba Confluence Health

  • General Acute Care Hospital
  • Wenatchee, WA
  • NPI 1881642239
  NPD

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736812800000",
    "number": "1780652792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4455 DRESSLER RD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182785",
            "telephone_number": "330-497-6555",
            "fax_number": "330-497-3281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 DRESSLER RD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182785",
            "telephone_number": "330-497-6555",
            "fax_number": "330-497-3281"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2925 Chicago Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554071321",
            "country_code": "US",
            "telephone_number": "651-241-9700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1401 Jefferson Hwy",
            "address_purpose": "LOCATION",
            "city": "New Orleans",
            "state": "LA",
            "postal_code": "701212426",
            "country_code": "US",
            "telephone_number": "504-842-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CHARLES",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35080468W",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "70831",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "330155",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000490965",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOMETOWN",
            "identifier": "Q016786D",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2374014",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUCKEYE COMMUNITY HEALTH",
            "identifier": "733074",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUMMACARE HEALTH PLAN",
            "identifier": "1074",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THREE RIVERS HEALTH PLANS",
            "identifier": "000000189519",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tava Requeal Walker
• Tiana A. Walker, M.A. ED
• Tomesha Walker
• Victoria Walker, MSPSY, BCBA, COBA
• Walking With a Purpose
• Corey Wallace
• Cynthia Wallace, MSW, LSW
• Deborah Wallace
• Lauren Elizabeth Wallace, LPCC
• Paige Wallace, LPCC-S, CCATP

• Family Medicine Physician in Canton, OH
• Providers in Canton, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 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.