Wallace Jack Schwam, M.D.

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

GFE12267 Issued in CA

Practice address

210 Indio Dr
Pismo Beach, CA 93449-1514

Phone

(805) 231-8699

NPI assigned

Jan 30, 2013

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1359504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359504000000",
    "number": "1902144694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1158",
            "city": "SOLVANG",
            "state": "CA",
            "postal_code": "934641158",
            "telephone_number": "805-231-8699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 INDIO DR",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934491514",
            "telephone_number": "805-231-8699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHWAM",
        "first_name": "WALLACE",
        "middle_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-01-30",
        "last_updated": "2013-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "GFE12267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Ruth Saslove, MSRD
• Scott Eric Schachter, O.D.
• Briana Leigh Schiro
• Marilyn Mullaney Schmidt, LMFT
• Mary Ann Schneider, PA-C
• Scott E Schachter Oda Professional Corporation
• Scott Robertson MD Inc
• Alexandria Settevendemie, PT, DPT
• Young Hoon Shin, PHARM,D
• Sierra Neuromonitoring LLC

• Geriatric Medicine (Internal Medicine) Physician in Pismo Beach, CA
• Providers in Pismo Beach, CA by specialty
• Geriatric Medicine (Internal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.