Active NPI
Keith Wallace
- Occupational Therapy Assistant
- Gilbert, AZ
National Provider Identifier
1831577337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 5853
- Practice address
- 4902 S Val Vista Dr
Suite B102
Gilbert, AZ 85298-7325 - Phone
- (480) 855-8866
- NPI assigned
- May 15, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 5853 | AZ | Primary |
Addresses
Primary practice location
4902 S Val Vista Dr
Suite B102
Gilbert, AZ 85298-7325
Mailing address
9432 E Conquistadores Dr
Scottsdale, AZ 85255-4343
Phone (602) 703-0748
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5853 | AZ | MD | Hematology & Oncology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| GS Consulting Group LLC | Past | Accepting new patients | |
| Industrial on-Site Network, LLC | Past | Accepting new patients |
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.
-
- Case Management Agency
- Gilbert, AZ
- NPI 1790978625
-
- Physical Therapist
- Gilbert, AZ
- NPI 1972982338
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1431648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431648000000",
"number": "1831577337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9432 E CONQUISTADORES DR",
"city": "SCOTTSDALE",
"state": "AZ",
"postal_code": "852554343",
"telephone_number": "602-703-0748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4902 S VAL VISTA DR",
"address_2": "SUITE B102",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852987325",
"telephone_number": "480-855-8866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "KEITH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-05-15",
"last_updated": "2015-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "AZ",
"license": "5853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gilbert, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.