Individual provider Active NPI

Barry Jay Wallman

  • Family Medicine Physician
  • Agoura Hills, CA
National Provider Identifier
1952318461
Registry record updated Apr 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G58527 Issued in CA
Practice address
29525 Canwood St
#305
Agoura Hills, CA 91301-4233
Phone
(818) 707-7789
Fax
(818) 707-7797
NPI assigned
Aug 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 22, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G58527 CA Primary

Addresses

Primary practice location

29525 Canwood St
#305
Agoura Hills, CA 91301-4233

Mailing address

29525 Canwood St
#305
Agoura Hills, CA 91301-4233
Phone (818) 707-7789

Other identifiers 2

IdentifierTypeStateIssuer
1952318461OtherCANPI NUMBER INDIVIDUAL
CB227753OtherCAPTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20101228000861 CA Practitioner - Family Practice 0840488755 Receives reassigned benefits from 1 practitioner
Practice locations: Agoura Hills, CA

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loyola University of Chicago, Stritch School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

30300 Agoura Rd
Suite 200
Agoura Hills, CA 91301-5413
Phone (818) 707-7789

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G58527CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Barry J Wallman MD Family Medicine CurrentSince Jun 15, 1991 Accepting new patients
West Hills Hospital Past Accepting new patients

Locations

29525 Canwood St
Ste 305
Agoura Hills, CA 91301
Phone (818) 707-7789

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429660800000",
    "number": "1952318461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29525 CANWOOD ST",
            "address_2": "#305",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913014233",
            "telephone_number": "818-707-7789",
            "fax_number": "818-707-7797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29525 CANWOOD ST",
            "address_2": "#305",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913014233",
            "telephone_number": "818-707-7789",
            "fax_number": "818-707-7797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLMAN",
        "first_name": "BARRY",
        "middle_name": "JAY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2015-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G58527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER INDIVIDUAL",
            "identifier": "1952318461",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "CB227753",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Agoura Hills, CA

Sources for this page

Verify at the official NPI Registry.