NPIMap

Individual provider Active NPI

Jacob Wallace, M.D.

  • Diagnostic Radiology Physician
  • Salina, KS
National Provider Identifier
1871974527
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
04-44613 Issued in KS
Practice address
119 W Iron Ave FL 5
Salina, KS 67401-2600
Phone
(785) 827-9526
Fax
(785) 827-2854
NPI assigned
Jun 17, 2015
Last updated
Mar 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 94-08609 KS
Diagnostic Radiology Physician 2085R0202X 04-44613 KS Primary

Addresses

Primary practice location

119 W Iron Ave FL 5
Salina, KS 67401-2600

Mailing address

119 W Iron Ave FL 5
Salina, KS 67401-2600
Phone (785) 827-9526

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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
I20210524001019 KS Practitioner - Diagnostic Radiology 0244544336 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Kansas School of Med (KC/Wich/Sal), 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
United Radiology Billing LLCGroup PAC ID 0446549265, 8 clinicians
Clay County Medical CenterGroup PAC ID 6901959436, shared by 8 NPIs, 44 clinicians

Practice addresses (Care Compare)

400 S Santa Fe Ave
Salina, KS 67401-4144
Phone (785) 825-8221

520 S Santa Fe Ave
Salina, KS 67401-4190
Phone (785) 825-8221

617 Liberty St
Clay Center, KS 67432-1564
Phone (785) 632-2144

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.93 of 100Reported as individual
Quality
86.81
Improvement activities
40
Cost
77.34

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
04-44613KSMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clay County Medical Center Diagnostic Radiology CurrentSince Nov 25, 2024 Accepting new patients
United Radiology Billing, LLC Diagnostic Radiology CurrentSince Jul 1, 2021 Accepting new patients
Clay County Medical Center Current Accepting new patients
Clay County Medical Center CurrentSince Nov 25, 2024 Accepting new patients
Advanced General Radiology LLC Diagnostic Radiology CurrentSince Jul 31, 2021 Accepting new patients

Locations

609 Liberty St
Clay Center, KS 67432
Phone (785) 632-2181

617 Liberty St
Clay Center, KS 67432
Phone (785) 632-2144

600 Medical Center Dr
Newton, KS 67114
Phone (316) 283-2700

119 W Iron Ave
Fl 5
Salina, KS 67401
Phone (785) 309-0355

520 S Santa Fe Ave
Salina, KS 67401
Phone (785) 309-1900

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1434499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1871974527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 W IRON AVE FL 5",
            "city": "SALINA",
            "state": "KS",
            "postal_code": "674012600",
            "telephone_number": "785-827-9526",
            "fax_number": "785-827-2854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 W IRON AVE FL 5",
            "city": "SALINA",
            "state": "KS",
            "postal_code": "674012600",
            "telephone_number": "785-827-9526",
            "fax_number": "785-827-2854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JACOB",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-17",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "94-08609",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "KS",
            "license": "04-44613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salina, KS

Sources for this page

Verify at the official NPI Registry.