Johanna Henderson Wallisa, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

01063488A Issued in IN

Practice address

702 Barnhill Dr
Room 2001
Indianapolis, IN 46202-5128

Phone

(317) 274-9981

NPI assigned

Sep 8, 2008

Sex

Female

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

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Anesthesiology

Education

Indiana University School of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northside Anesthesia Services, LLCGroup PAC ID 7719891027, 94 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St Vincent Hospital Hospital, Indianapolis, IN, CCN 150084

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Northside Anesthesia Services, LLC

  • Anesthesiology Physician
  • Indianapolis, IN
  • NPI 1568444693
  Medicare reassignment Care Compare group

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

• St. Vincent Hospital & Health Care Center, Inc.

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1306898960
  Care Compare affiliation
• St. Vincent Hospital & Health Care Center, Inc.

  • General Acute Care Hospital
  • Avon, IN
  • NPI 1851833230
  Care Compare affiliation

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

{
    "created_epoch": "1220832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220832000000",
    "number": "1932357407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4809 MELBOURNE RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462282090",
            "telephone_number": "317-985-5894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 BARNHILL DR",
            "address_2": "ROOM 2001",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025128",
            "telephone_number": "317-274-9981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLISA",
        "first_name": "JOHANNA",
        "middle_name": "HENDERSON",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-08",
        "last_updated": "2008-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": "01063488A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara J Walling, FNP
• Guy R Walling, NP NURSE PRACTITIONE
• Martina Lynn Walling, PHARMD
• Radhika V Walling, M.D.
• Eric D Wallisa, M.D.
• Brooke Felicia Walls, MD
• Caren Walls, ATC
• Deborah Renee Walls, SOCIAL WORKER - CLIN
• Jenna Elise Walls, M.D.
• Joshua Quincy Walls

• Anesthesiology Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Anesthesiology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2008; 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.