NPIMap

Individual provider Active NPI

Waymon L Wallace, MD

  • Internal Medicine Physician
  • Cincinnati, OH
National Provider Identifier
1841213667
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35076674 Issued in OH
Practice address
1577 Goodman Ave Ste a
Cincinnati, OH 45224-1044
Phone
(513) 403-3762
Fax
(513) 521-6403
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35076674 OH Primary

Addresses

Primary practice location

1577 Goodman Ave Ste a
Cincinnati, OH 45224-1044

Mailing address

PO Box 40535
Cincinnati, OH 45240-0535
Phone (513) 403-3762

Other practice location 1

5150 Sandy Ln
Fairfield, OH 45014-2738
Phone (513) 896-9595

Other identifiers 1

IdentifierTypeStateIssuer
2232177MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20040927001175 OH Practitioner - Internal Medicine 7315916335 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wright State University Boonshoft School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1577 Goodman Ave
Suite a
Cincinnati, OH 45224-1044
Phone (513) 521-3600

Hospital & facility affiliations

  • American Mercy Home Care, LLC Home health agency, Cincinnati, OH, CCN 367167
  • Bella Care Hospice Hospice, Westerville, OH, CCN 361646
  • Hospice of Cincinnati, Inc Hospice, Cincinnati, OH, CCN 361531
  • Mercy Health - Fairfield Hospital Hospital, Fairfield, OH, CCN 360056
  • Good Samaritan Hospital Hospital, Cincinnati, OH, CCN 360134
  • Home at Taylor'S Pointe Nursing home, Cincinnati, OH, CCN 366332
  • Veranda Gardens Nursing & Rehabilitation Center Nursing home, Cincinnati, OH, CCN 366347

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Residential Management Systems, Inc.-Springlawn Past Accepting new patients
Residential Management Systems, Inc.-Carini Past Accepting new patients
Residential Management Systems, Inc.-Hanfield Past Accepting new patients
CHS - Springdale, Inc Past Accepting new patients
Residential Management Systems, Inc.-Thomwood Past Accepting new patients
Residential Management Systems, Inc.-Longmeadow Past Accepting new patients
Res-Care Ohio, Inc. Past Accepting new patients
Camelot Realty, LLC Past Accepting new patients
CHS - Colerain, Inc. Past Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Veranda Gardens Nursing & Rehabilitation CenterCincinnati, OH, CCN 366347 Skilled nursing facility Adp of the SNF Jun 1, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 10

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1841213667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40535",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452400535",
            "telephone_number": "513-403-3762",
            "fax_number": "513-521-6403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1577 GOODMAN AVE STE A",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452241044",
            "telephone_number": "513-403-3762",
            "fax_number": "513-521-6403"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5150 Sandy Ln",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "OH",
            "postal_code": "450142738",
            "country_code": "US",
            "telephone_number": "513-896-9595",
            "fax_number": "513-896-4171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "WAYMON",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35076674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2232177",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.