Steven Gregory Wallace Jr., PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PAT9107761 Issued in FL

Practice address

511 W Alexander St
Plant City, FL 33563-7116

Phone

(813) 659-9800

NPI assigned

Jan 9, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

98

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Emergency Physicians Inc

  • Emergency Medicine Physician
  • Jacksonville, FL
  • NPI 1285686675
  Medicare reassignment
• Florida Em-I Medical Services PA

  • Emergency Medicine Physician
  • Lakeland, FL
  • NPI 1871542720
  NPD (past)

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

{
    "created_epoch": "1389225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389225600000",
    "number": "1851713952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5026 FAIRFAX DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338132917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 W ALEXANDER ST",
            "city": "PLANT CITY",
            "state": "FL",
            "postal_code": "335637116",
            "telephone_number": "813-659-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "STEVEN",
        "middle_name": "GREGORY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-01-09",
        "last_updated": "2014-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PAT9107761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Walgreens
• Jilles Walker
• Jennifer L Walkinshaw, ARNP
• Roxanne Marie Walkowiak, OD
• Edward Waller Jr.
• Melissa Carrie Walters, PHARMD
• Taylor Elizabeth Warf, RBT
• Gillian Warren, DPT
• Chastity Washington

• Physician Assistant in Plant City, FL
• Providers in Plant City, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2014; 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.