Susan Dale Wall, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

28400 Issued in IA

Practice address

521 Westbury Dr Ste 2
Iowa City, IA 52245-2727

Phone

(319) 339-3872

Fax

(319) 339-3874

NPI assigned

Jan 9, 2006

Sex

Female

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 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Merit-based Incentive Payment System (MIPS)

Final score

97.45 of 100Reported as group

Promoting interoperability

97

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: susan.wall@forefrontdermatology.emadirect.md

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.

• Ic Dermatology PC

  • Dermatology Physician
  • Iowa City, IA
  • NPI 1952549792
  NPD (past)

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

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1962480970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 WESTBURY DR STE 2",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522452727",
            "telephone_number": "319-339-3872",
            "fax_number": "319-339-3874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "SUSAN",
        "middle_name": "DALE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-09",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "IA",
            "license": "28400",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IA",
            "license": "28400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0079301",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Susan.Wall@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "521 Westbury Dr Ste 2",
            "city": "Iowa City",
            "state": "IA",
            "country_code": "US",
            "postal_code": "522452727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jerry Dean Walker, DDS
• Kristen Followwill Walker, DO
• Leandra Walker
• Sarah K. Walker, M.D.
• Michael Wall, MD
• Alexander Andrew Wallace, MD
• Anne Marie Wallace, MA, CCC/SLP
• Jessica Lynne Wallace, NNP-BC
• Nakkia Wallace, RN
• Peter Dart Wallace, M.D.

• Dermatology Physician in Iowa City, IA
• Providers in Iowa City, IA by specialty
• Dermatology Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.