Wallace Dale Prophet, MD

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

49643 Issued in MT

Practice address

350 Heritage Way
Suite 2100
Kalispell, MT 59901-3158

Phone

(406) 257-8992

Fax

(406) 755-4161

NPI assigned

Sep 9, 2005

Last updated

Aug 22, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.146033

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.

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• Pulmonary Associates, PA

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  NPD

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503360000000",
    "number": "1942294426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 HERITAGE WAY",
            "address_2": "SUITE 2100",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013158",
            "telephone_number": "406-257-8992",
            "fax_number": "406-755-4161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 HERITAGE WAY",
            "address_2": "SUITE 2100",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013158",
            "telephone_number": "406-257-8992",
            "fax_number": "406-755-4161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROPHET",
        "first_name": "WALLACE",
        "middle_name": "DALE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2017-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "AL",
            "license": "9734",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MT",
            "license": "49643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000012909",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00284468A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "068414700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Richard W Puchta, D.C.
• Lynda L Purdy, DC.
• Mallory Louise Pursley, ARNP

• Pulmonary Disease Physician in Kalispell, MT
• Providers in Kalispell, MT by specialty
• Pulmonary Disease Physician in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2017; 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.