NPIMap

Individual provider Active NPI

Brian Wallace, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Baltimore, MD
National Provider Identifier
1801864350
Registry record updated Feb 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
D31136 Issued in MD
Practice address
9005 Kilbride Rd
Baltimore, MD 21236-2017
Phone
(443) 904-6999
NPI assigned
Mar 10, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 28, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X D31136 MD Primary

Addresses

Primary practice location

9005 Kilbride Rd
Baltimore, MD 21236-2017

Mailing address

9005 Kilbride Rd
Baltimore, MD 21236-2017
Phone (443) 904-6999

Other identifiers 1

IdentifierTypeStateIssuer
372141800MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101129000752 MD Practitioner - Internal MedicinePractitioner - Geriatric Medicine 5698961977 Practice locations: Baltimore, MD

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Medical College of Georgia School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9005 Kilbride Rd
Baltimore, MD 21236-2017
Phone (443) 904-6999

Hospital & facility affiliations

  • Home Call, Inc Home health agency, Westminster, MD, CCN 217115
  • Medstar Health Home Care Home health agency, Baltimore, MD, CCN 217068
  • Bayada Home Health Care, Inc. Home health agency, Towson, MD, CCN 217101
  • Amedisys Home Health Care Home health agency, Forest Hill, MD, CCN 217045
  • Amedisys Home Health Home health agency, Rosedale, MD, CCN 217094
  • Gilchrist Hospice Care, Inc Hospice, Hunt Valley, MD, CCN 211526
  • Johns Hopkins Bayview Medical Center Hospital, Baltimore, MD, CCN 210029

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Frederick Health Hospital Inc Past Accepting new patients
Genesis Elder Care Physician Services LLC Geriatric Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: brian.wallace.1@7613.direct.athenahealth.com

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 and National Provider Directory roles.

Hospital & facility affiliations 11

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": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362009600000",
    "number": "1801864350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9005 KILBRIDE RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212362017",
            "telephone_number": "443-904-6999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9005 KILBRIDE RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212362017",
            "telephone_number": "443-904-6999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-10",
        "last_updated": "2013-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MD",
            "license": "D31136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "372141800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.