Bryan T Wall, MD

Primary specialty

Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X

License

36177 Issued in AZ

Practice address

18444 N 25TH Ave
Ste 210
Phoenix, AZ 85023-1264

Phone

(623) 537-5600

Fax

(866) 939-2673

NPI assigned

Jun 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in AZ

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

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.

• Center for Orthopedic Research and Education, LLC

  • Orthopaedic Surgery Physician
  • Phoenix, AZ
  • NPI 1427095801
  Medicare reassignment NPD
• Center for Orthopedic Research and Education LLC

  • Durable Medical Equipment & Medical Supplies
  • Flagstaff, AZ
  • NPI 1063251056
  NPD
• Center for Orthopedic Research and Educatoin

  • Physical Therapist
  • Mesa, AZ
  • NPI 1275967408
  NPD
• Center for Orthopedic Research and Education Inc

  • Durable Medical Equipment & Medical Supplies
  • Prescott, AZ
  • NPI 1447490321
  NPD (past)

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1790712792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18444 N 25TH AVE",
            "address_2": "STE 310",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850231266",
            "telephone_number": "623-537-5600",
            "fax_number": "866-939-2673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18444 N 25TH AVE",
            "address_2": "STE 210",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850231264",
            "telephone_number": "623-537-5600",
            "fax_number": "866-939-2673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "BRYAN",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AZ",
            "license": "36177",
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "AZ",
            "license": "36177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC ANTHEM",
            "identifier": "5550830006",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC SWV",
            "identifier": "5550830008",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC AZ NORTH",
            "identifier": "5550830009",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC DV",
            "identifier": "5550830007",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC GILBERT",
            "identifier": "5550830010",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00618125",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC PEORIA",
            "identifier": "5550830003",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159666",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC SCW",
            "identifier": "5550830001",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC PV",
            "identifier": "5550830004",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Marie Walker, PA-C
• Tony Walker
• Virginia Sue Walker, LPN
• Michael Denis Walkow
• Timothy William Walkowiak, NP-C
• Clarence R Wall, M.D.
• Heather Wall, LCSW
• Jillian Marie Wall, M.D.
• Liberty Morgan Wall
• Michael Vincent Wall, D.D.S.

• Adult Reconstructive Orthopaedic Surgery Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Adult Reconstructive Orthopaedic Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; 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.