Teresa L Wallace, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00025633 Issued in WA

Practice address

3915 Talbot Rd S
Ste 401
Renton, WA 98055-5738

Phone

(425) 656-4224

Fax

(405) 656-5096

NPI assigned

Jul 31, 2006

Sex

Female

Sole proprietor

No

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 WA

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

Family Practice

Education

New York Medical College, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valley Medical Group-RentonGroup PAC ID 4183753965, 419 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Valley Medical Center Hospital, Renton, WA, CCN 500088

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: twallace7042@direct.valleymed.org

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.

• Valley Medical Group-Renton

  • General Acute Care Hospital
  • Renton, WA
  • NPI 1619209574

  Family Medicine

  Medicare reassignment Care Compare group NPD

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

• Public Hospital District 1 of King County

  • General Acute Care Hospital
  • Renton, WA
  • NPI 1649209230
  Care Compare affiliation
• Valley Medical Group-Renton

  • General Acute Care Hospital
  • Renton, WA
  • NPI 1619209574
  Care Compare affiliation

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347840000000",
    "number": "1871509646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 LIND AVE SW",
            "address_2": "STE 100",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574934",
            "telephone_number": "425-656-5412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3915 TALBOT RD S",
            "address_2": "STE 401",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555738",
            "telephone_number": "425-656-4224",
            "fax_number": "405-656-5096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TERESA",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2012-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00025633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy Rae Walker, P.T.
• Johanne B Wall
• Richard J Wall, MD
• Anna Wallace
• Diana Wallace, OT
• Judith I Waller, PT
• Walmart Inc.
• Laura Walsh, MD, PHD
• Marie Walter, OT
• Victoria Walter

• Family Medicine Physician in Renton, WA
• Providers in Renton, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; 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.