Colleen Rae Wallis, P.A.C.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

R 1069736 Issued in MN

Practice address

3605 Mayfair Ave
Hibbing, MN 55746-2923

Phone

(218) 262-3441

Fax

(218) 362-6989

NPI assigned

May 4, 2006

Last updated

Jul 11, 2013By the provider in NPPES

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

Other names 1

• Colleen Rae Walker Former name

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Physician Assistant

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Range Regional Health ServicesGroup PAC ID 8022920024, 349 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Range Regional Health Services Hospital, Hibbing, MN, CCN 240040

Merit-based Incentive Payment System (MIPS)

Final score

96.93 of 100Reported as group

Quality

94.88

Promoting interoperability

100

Improvement activities

40

Cost

78.21

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cwallis291524@fairview.direct-ci.com

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.

• Range Regional Health Services

  • Clinic/Center
  • Hibbing, MN
  • NPI 1669569265
  Medicare reassignment Care Compare group NPD
• Range Regional Health Services

  dba HealthLine Medical Supply

  • Durable Medical Equipment & Medical Supplies
  • International Falls, MN
  • NPI 1710954821
  NPD
• Range Regional Health Services

  • General Acute Care Hospital
  • Hibbing, MN
  • NPI 1356321699
  NPD (past)

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

• Range Regional Health Services

  • General Acute Care Hospital
  • Hibbing, MN
  • NPI 1356321699
  Care Compare affiliation

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373500800000",
    "number": "1922066117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 MAYFAIR AVE",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557462923",
            "telephone_number": "218-262-3441",
            "fax_number": "218-362-6989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3605 MAYFAIR AVE",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557462923",
            "telephone_number": "218-262-3441",
            "fax_number": "218-362-6989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "COLLEEN",
        "middle_name": "RAE",
        "credential": "P.A.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2013-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "R 1069736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLEEN",
            "last_name": "WALKER",
            "middle_name": "RAE",
            "credential": "P.A.C.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristal Ruth Waara
• Krista Kate Wagner, OTR
• Mark Darrel Wagner
• Wal-Mart Stores, Inc. (Vision Center 30-2937)
• Walgreen Co (Walgreens #11125)
• Walmart Inc. (Walmart Pharmacy 10-2937)
• Katelyn Ashley Wamhoff, LICSW
• Katelin Warner
• Kayla Marie Warren, DPT
• Gwen Geneen Washburn, MS, CCC-A

• Physician Assistant in Hibbing, MN
• Providers in Hibbing, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 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.
• 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.