Robert William Wallace II

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

326195 Issued in LA

Practice address

5000 Hennessy Blvd
Baton Rouge, LA 70808-4375

Phone

(225) 765-4050

Fax

(225) 765-4046

NPI assigned

Mar 20, 2017

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

Medicare fee-for-service enrollment

Enrolled in LA

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

Specialty

Internal Medicine

Education

Louisiana State University School of Medicine in New Orleans, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Our Lady of the Lake Physician Group LLCGroup PAC ID 4587849781, 637 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Amedisys Home Health Home health agency, Baton Rouge, LA, CCN 197437
• Audubon Home Health Home health agency, Baton Rouge, LA, CCN 197771
• Hospice Compassus - Baton Rouge Hospice, Baton Rouge, LA, CCN 191640
• Our Lady of the Lake Regional Medical Center Hospital, Baton Rouge, LA, CCN 190064

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/R4/

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.

• Our Lady of the Lake Physician Group LLC

  • Internal Medicine Physician
  • Baton Rouge, LA
  • NPI 1033494943
  Medicare reassignment Care Compare group NPD
• Our Lady of the Lake Physician Group LLC

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Baton Rouge, LA
  • NPI 1235912502
  NPD
• Our Lady of the Lake Hospital Inc.

  • General Acute Care Hospital
  • Baton Rouge, LA
  • NPI 1366436123
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Amedisys Louisiana, LLC

  • Home Health Agency
  • Baton Rouge, LA
  • NPI 1588612360
  Care Compare affiliation
• Audubon Home Health Inc

  • Home Health Agency
  • Baton Rouge, LA
  • NPI 1861459398
  Care Compare affiliation
• Hospice Care of Louisiana, LLC

  • Community Based Hospice Care Agency
  • Baton Rouge, LA
  • NPI 1023129160
  Care Compare affiliation
• Our Lady of the Lake Hospital Inc.

  • General Acute Care Hospital
  • Baton Rouge, LA
  • NPI 1366436123
  Care Compare affiliation

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

{
    "created_epoch": "1489968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618790400000",
    "number": "1801337134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 N SILVER MAPLE DR",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704585483",
            "telephone_number": "504-554-2131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 HENNESSY BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084375",
            "telephone_number": "225-765-4050",
            "fax_number": "225-765-4046"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "204 N Silver Maple Dr",
            "address_purpose": "LOCATION",
            "city": "Slidell",
            "state": "LA",
            "postal_code": "704585483",
            "country_code": "US",
            "telephone_number": "504-554-2131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ROBERT",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-20",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "326195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austin H Wallace, PA
• Chloie Wallace
• Delania Michelle Wallace
• Ebony Lashawn Wallace
• Henry Neal Wallace, CIT
• Tierney Wallace
• Karen B Wallen, NP
• Mary Waller, M.ED., LPC, NCC
• Zadiee Waller, LMSW
• Nancy McMorris Walls, RN, MSN, FNP

• Internal Medicine Physician in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 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.