Individual provider Active NPI

Adam John Wallenta, PA-C

  • Medical Physician Assistant
  • Omak, WA
National Provider Identifier
1790310977
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA61218697 Issued in WA
Practice address
916 Koala Dr
Omak, WA 98841-9759
Phone
(509) 663-8711
NPI assigned
Mar 7, 2020
Last updated
Dec 9, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA61218697 WA Primary

Addresses

Primary practice location

916 Koala Dr
Omak, WA 98841-9759

Mailing address

820 N Chelan Ave
Wenatchee, WA 98801-2028
Phone (509) 663-8711

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://epicoxy.et0764.epichosted.com/FHIRProxy/api/FHIR/Rpr4/
Direct Messaging Address awallenta97054@edirect.chehr.org

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211118001575 WA Practitioner - Physician Assistant 0244629921 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1201 S Miller St
Wenatchee, WA 98801-3201
Phone (509) 662-2208

1215 S Miller St
Wenatchee, WA 98801-3201
Phone (509) 665-6087

820 N Chelan Ave
Wenatchee, WA 98801-2028
Phone (509) 663-8711

840 E Hill Ave
Moses Lake, WA 98837-2238
Phone (509) 663-8711

916 Koala Dr
Omak, WA 98841-9759
Phone (509) 663-8711

933 Red Apple Rd
Wenatchee, WA 98801-3370
Phone (509) 663-8711

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA61218697WAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Central Washington Health Services Association CurrentSince Apr 1, 2024 Accepting new patients

Locations

916 Koala Dr
Omak, WA 98841
Phone (509) 826-1800

1201 S Miller St
Wenatchee, WA 98801
Phone (509) 662-2208

820 N Chelan Ave
Wenatchee, WA 98801
Phone (509) 863-4868

933 Red Apple Rd
Wenatchee, WA 98801
Phone (509) 655-6125

Interoperability endpoints

  • Direct secure messaging: awallenta97054@edirect.chehr.org

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 3

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": "1583539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1790310977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 N CHELAN AVE",
            "city": "WENATCHEE",
            "state": "WA",
            "postal_code": "988012028",
            "telephone_number": "509-663-8711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 KOALA DR",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "988419759",
            "telephone_number": "509-663-8711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLENTA",
        "first_name": "ADAM",
        "middle_name": "JOHN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-07",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA61218697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicoxy.et0764.epichosted.com/FHIRProxy/api/FHIR/Rpr4/",
            "affiliation": "N",
            "address_1": "916 Koala Dr",
            "city": "Omak",
            "state": "WA",
            "country_code": "US",
            "postal_code": "988419759",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awallenta97054@edirect.chehr.org",
            "affiliation": "N",
            "address_1": "916 Koala Dr",
            "city": "Omak",
            "state": "WA",
            "country_code": "US",
            "postal_code": "988419759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Omak, WA

Sources for this page

Verify at the official NPI Registry.