Robin E. Wallace, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110002610 Issued in VA

Practice address

6160 Kempsville Cir Ste 325a
Norfolk, VA 23502-3933

Phone

(757) 354-2885

Fax

(757) 917-5141

NPI assigned

Sep 27, 2007

Sex

Female

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 6

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Mid Atlantic Long Term Specialty Care LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Norfolk, VA
  • NPI 1851909998
  Medicare reassignment
• Mid-Atlantic Post Acute & Long Term Care PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Norfolk, VA
  • NPI 1225557556
  Medicare reassignment
• SE Virginia Value Based Care, LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Norfolk, VA
  • NPI 1225720501
  Medicare reassignment

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

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1942497631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6160 KEMPSVILLE CIR STE 325A",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235023933",
            "telephone_number": "757-354-2885",
            "fax_number": "757-917-5141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6160 KEMPSVILLE CIR STE 325A",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235023933",
            "telephone_number": "757-354-2885",
            "fax_number": "757-917-5141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16463 Dahlgren Rd",
            "address_purpose": "LOCATION",
            "city": "King George",
            "state": "VA",
            "postal_code": "224855810",
            "country_code": "US",
            "telephone_number": "540-644-9505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ROBIN",
        "middle_name": "E.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-27",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110002610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE/CHAMPUS",
            "identifier": "-022",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMA HEALTH",
            "identifier": "10115900P",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942497631",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8101130",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORVEL",
            "identifier": "PAR",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "USA MANAGED CARE",
            "identifier": "PAR",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Florence Chen Walko, M.S. CCC-SLP
• Shelby M Wall, NP
• Cydney T Wallace, DPT
• John Wallace Sr., IDC
• Logan Grace Gary Wallace, MD
• Taylor Sterling Wallace, M.D.
• Diane Marie Wallach, OD
• Daniel Waller
• Eva Jayne Waller, M.D.
• Jerri Ashley Waller, MD

• Physician Assistant in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.