Lewis Alfred Wallace, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

3060 Issued in OK

Practice address

1921 Stonecipher Blvd
Ada, OK 74820

Phone

(580) 421-4570

NPI assigned

Aug 23, 2005

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 names 1

• Fred Wallace Other name

Medicare fee-for-service enrollment

Enrolled in TX

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

Internal Medicine

Education

Oklahoma State University College of Osteopathic Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chickasaw Nation Division of Health Chickasaw Nation Medical CenterGroup PAC ID 8426957523, 243 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Chickasaw Nation Medical Center Hospital, Ada, OK, CCN 370180

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Chickasaw Nation Division of Health

  dba Chickasaw Nation Medical Center

  • General Acute Care Hospital
  • Ada, OK
  • NPI 1255364923

  TX

  Medicare reassignment Care Compare group NPD
• Chickasaw Nation Division of Health

  dba Chickasaw Nation Purcell Clinic

  • Primary Care Clinic/Center
  • Purcell, OK
  • NPI 1982764395
  NPD
• Chickasaw Nation Division of Health Chickasaw Nation Medical Center

  dba Minticha Apila

  • Home Health Agency
  • Ada, OK
  • NPI 1811739071
  NPD
• Chickasaw Nation Division of Health Chickasaw Nation Medical Center

  dba Chickasaw Nation DME

  • Durable Medical Equipment & Medical Supplies
  • Ada, OK
  • NPI 1295399095
  NPD (past)

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

• Chickasaw Nation Division of Health

  dba Chickasaw Nation Medical Center

  • General Acute Care Hospital
  • Ada, OK
  • NPI 1255364923
  Care Compare affiliation
• Chickasaw Nation Division of Health

  dba Chickasaw Nation Tishomingo Clinic

  • Primary Care Clinic/Center
  • Tishomingo, OK
  • NPI 1649330242

  Hospital

  Care Compare affiliation
• Chickasaw Nation Division of Health

  dba Chickasaw Nation Ardmore Clinic

  • Primary Care Clinic/Center
  • Ardmore, OK
  • NPI 1730249186

  Hospital

  Care Compare affiliation
• Chickasaw Nation Division of Health

  dba Chickasaw Nation Purcell Clinic

  • Primary Care Clinic/Center
  • Purcell, OK
  • NPI 1982764395

  Hospital

  Care Compare affiliation
• Chickasaw Nation Division of Health Chickasaw Nation Medical Center

  • Primary Care Clinic/Center
  • Ada, OK
  • NPI 1962563148

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473811200000",
    "number": "1942292271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 STONECIPHER BLVD",
            "city": "ADA",
            "state": "OK",
            "postal_code": "74820",
            "telephone_number": "580-421-4570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 STONECIPHER BLVD",
            "city": "ADA",
            "state": "OK",
            "postal_code": "74820",
            "telephone_number": "580-421-4570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LEWIS",
        "middle_name": "ALFRED",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2016-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "3060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FRED",
            "last_name": "WALLACE",
            "credential": "D.O.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Doyle Matthew Walker, P.T.
• Ron Gene Walkup, D.D.S.
• Tammi Walkup
• Melissa Jean Wall, BHRS II
• Vernon Wall, PHARMD
• Tonie Waller, DDS
• Kandice Wallis
• Makenzi Ann Walls
• Karen Ruth Walters, RN
• Shelly D Walters, MD

• Internal Medicine Physician in Ada, OK
• Providers in Ada, OK by specialty
• Internal Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; 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.