Cory L Wallace, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

2047 Issued in TX

Practice address

8715 Village Dr Ste 400
San Antonio, TX 78217-5407

Phone

(210) 732-3668

Fax

(210) 732-3338

NPI assigned

Jul 27, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Cory Wells Former name

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Temple University School of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellmed Networks, Inc.Group PAC ID 6002091261, 116 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Wellmed Networks, Inc.

  • Cardiovascular Disease Physician
  • San Antonio, TX
  • NPI 1386948677
  Medicare reassignment Care Compare group NPD
• Lonestar Podiatry & Surgery PA

  • Foot & Ankle Surgery Podiatrist
  • San Antonio, TX
  • NPI 1558577098
  NPD (past)
• Wellmed Medical Group, PA

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1437156486
  NPD (past)

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

{
    "created_epoch": "1280188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631232000000",
    "number": "1780998112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8715 VILLAGE DR",
            "address_2": "STE 400",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782175407",
            "telephone_number": "210-732-3668",
            "fax_number": "210-732-3338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8715 VILLAGE DR STE 400",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782175407",
            "telephone_number": "210-732-3668",
            "fax_number": "210-732-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CORY",
        "middle_name": "L",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-27",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "TX",
            "license": "2047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WMG PTAN",
            "identifier": "297723YMVU",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CORY",
            "last_name": "WELLS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Andrew Wallace Jr.
• Annmarie Wallace, CRNA
• Ashley Wallace, DDS
• Chad Ryan Wallace, RN
• Christopher L. Wallace, M.D.
• Derek James Wallace
• Diane P. Wallace, OTR
• Gloria T Wallace
• Jandale Wallace
• Jaynel Lynn Wallace

• Foot & Ankle Surgery Podiatrist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Foot & Ankle Surgery Podiatrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; 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.