NPIMap

Individual provider Active NPI

Christopher M B Wallis, PA-C

  • Physician Assistant
  • Lebanon, OR
National Provider Identifier
1891866513
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01247 Issued in OR
Practice address
191 N Main St
Lebanon, OR 97355-2870
Phone
(541) 451-7940
NPI assigned
Nov 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA01247 OR Primary

Addresses

Primary practice location

191 N Main St
Lebanon, OR 97355-2870

Mailing address

PO Box 1193
Corvallis, OR 97339-1193

Other practice location 1

140 E Main St
Othello, WA 99344
Phone (509) 488-5256

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cwallis7041@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20071105000170 OR Practitioner - Physician Assistant 1951494491 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

113 S Hwy 101
Warrenton, OR 97146-9314
Phone (503) 861-6500

725 S Wahanna Rd
Seaside, OR 97138-7735
Phone (503) 717-7000

727 S Wahanna Rd
Seaside, OR 97138-7735
Phone (503) 717-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.44 of 100Reported as group
Quality
87
Promoting interoperability
100
Improvement activities
40
Cost
73.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA01247ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon CurrentSince Feb 1, 2022 Accepting new patients
Providence Health & Services Oregon CurrentSince Feb 1, 2022 Accepting new patients
Firstcare Medical Foundation Physician Assistant Past Accepting new patients
Providence Health & Services Oregon Past Accepting new patients

Locations

727 S Wahanna Rd
Seaside, OR 97138
Phone (503) 717-7000

725 S Wahanna Rd
Seaside, OR 97138
Phone (503) 717-7000

Interoperability endpoints

  • Direct secure messaging: cwallis2057735@oc.providencedirect.org
  • Direct secure messaging: cwallis7041@samhealth.direct-ci.com

Organizations & group practices 4

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1891866513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1193",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 N MAIN ST",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973552870",
            "telephone_number": "541-451-7940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "140 E Main St",
            "address_purpose": "LOCATION",
            "city": "Othello",
            "state": "WA",
            "postal_code": "99344",
            "country_code": "US",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "CHRISTOPHER",
        "middle_name": "M B",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA01247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwallis7041@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "191 N Main St",
            "city": "Lebanon",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973552870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lebanon, OR

Sources for this page

Verify at the official NPI Registry.