Terry L Hallwachs, PA
Individual provider Active NPI Physician Assistant · Oak Ridge, TN
NPI 1962448860 · NPPES record last updated Jul 27, 2017
Key facts
- NPI
- 1962448860
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 1571 (TN)
- Practice address
- 988 Oak Ridge Tpke
Suite 100
Oak Ridge, TN 37830-6930 - Phone
- (865) 483-8478
- Fax
- (865) 483-4194
- NPI assigned
- Jun 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- South Lincoln Hospital District
Practice addresses (Care Compare)
1105 Cedar Ave
Kemmerer, WY 83101-3231
711 Onyx St
Kemmerer, WY 83101-3214
Phone 30787744013115
Hospital & facility affiliations
- South Lincoln Medical Center - Cah
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN, WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080207000340 | TN | Practitioner - Physician Assistant | 6103899885 | Reassigns benefits to 1 organization |
| I20201022000221 | WY | Practitioner - Physician Assistant | 6103899885 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1571 | TN | MD | Mental Health Counselor |
| 3957 | GA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Lincoln Hospital District | Current |
Accepting new patients | |
| South Lincoln Hospital District | Current |
Accepting new patients | |
| Campbell County Hospital District | Current | Accepting new patients | |
| Campbell County Hospital District, | Current |
Accepting new patients | |
| Campbell County Hospital District | Current |
Accepting new patients | |
| South Lincoln Hospital District | Past | Accepting new patients | |
| South Lincoln Hospital District | Past | Accepting new patients | |
| Sterling Emergency Services of the Southeast Inc | Medical | Past | Accepting new patients |
| South Lincoln Hospital District | Past | Accepting new patients |
Locations
501 S Burma Ave
Fl 3
Gillette, WY 82716
Phone (307) 688-3636
501 S Burma Ave
Gillette, WY 82716
Phone (307) 682-8811
711 Onyx St
Kemmerer, WY 83101
Phone (307) 877-4401
Interoperability endpoints
- terry.hallwachs.1@16971.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 3957 | GA | |
| Medical Physician Assistant | 363AM0700X | 1571 | TN | |
| Physician Assistant | 363A00000X | 1571 | TN | Yes |
Addresses
Primary practice location
988 Oak Ridge Tpke
Suite 100
Oak Ridge, TN 37830-6930
Mailing address
308 N Peters Rd
Suite 225
Knoxville, TN 37922-2356
Phone (865) 694-7725
Other providers in Oak Ridge, TN
- Amanda Danielle Hall
- Cassandra Shea Hall
- Pamela L Hall
- Richard Gene Hall
- Stacy L Hall
- Brooke Lorraine Hamby
- Jessica Lynn Hamby
- Holly Nicole Hamil
- Stella Hamilton
- Allison L Hammer
All providers in Oak Ridge, TN · Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.