Scott Michael Wallace, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

16487 Issued in NV

Practice address

75 Pringle Way
Ste 300
Reno, NV 89502-1464

Phone

(775) 982-5000

Fax

(775) 982-3900

NPI assigned

Apr 10, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Renown Regional Medical Center

  • General Acute Care Hospital
  • Reno, NV
  • NPI 1124098421
  NPD (past)
• Zucker Horsley Tatem Althoff Professional Corp

  • Pediatrics Physician
  • Reno, NV
  • NPI 1154302149
  NPD (past)

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

{
    "created_epoch": "1365552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472688000000",
    "number": "1922441880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 KUENZLI ST",
            "address_2": "STE 202",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895020845",
            "telephone_number": "775-982-5262",
            "fax_number": "775-982-5496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 PRINGLE WAY",
            "address_2": "STE 300",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895021464",
            "telephone_number": "775-982-5000",
            "fax_number": "775-982-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SCOTT",
        "middle_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-10",
        "last_updated": "2016-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NV",
            "license": "16487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13804974",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caitlyn Maureen Wallace, LCSW
• Clinton Edward Wallace
• David Lamonte Wallace
• James Alexander Wallace III, PT
• Kelsey Wallace
• Trevor Wallace
• Trudy Wallace, RD
• Carly Waller
• Kailee Waller, RN
• Kelly Waller

• Pediatrics Physician in Reno, NV
• Providers in Reno, NV by specialty
• Pediatrics Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.