Active NPI
Paul A Wallis, PA-C
- Physician Assistant
- Cleveland, OH
National Provider Identifier
1932186541
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 50-001348
- Practice address
- 18697 Bagley Rd
Cleveland, OH 44130-3417 - Phone
- (440) 816-8000
- NPI assigned
- Dec 23, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 50-001348 | OH | Primary |
Addresses
Primary practice location
18697 Bagley Rd
Cleveland, OH 44130-3417
Mailing address
PO Box 634434
Cincinnati, OH 45263-0001
Phone (440) 879-0081
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000346913 | Other | OH | ANTHEM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50-001348 | OH | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184112000000",
"number": "1932186541",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 634434",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452630001",
"telephone_number": "440-879-0081",
"fax_number": "440-879-0084"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18697 BAGLEY RD",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441303417",
"telephone_number": "440-816-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLIS",
"first_name": "PAUL",
"middle_name": "A",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-23",
"last_updated": "2007-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OH",
"license": "50-001348",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000346913",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.