Jack Wesley Wallis, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G8488 Issued in TX

Practice address

2108 Hunter Rd
Suite 116
San Marcos, TX 78666-5156

Phone

(512) 754-7700

Fax

(512) 754-0012

NPI assigned

Nov 17, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Family Practice

Education

Other, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Seton Family of DoctorsGroup PAC ID 0941333280, 785 clinicians

David P Ellent PLLCGroup PAC ID 7012290885, 57 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christus Homecare Home health agency, New Braunfels, TX, CCN 677544
• Christus Santa Rosa Hospital-San Marcos Hospital, San Marcos, TX, CCN 450272

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jack.wallis.1@19704.direct.athenahealth.com

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.

• David P Ellent PLLC

  • Hematology & Oncology Physician
  • Spring, TX
  • NPI 1245777440
  Medicare reassignment Care Compare group NPD
• Seton Family of Doctors

  • Neurological Surgery Physician
  • Austin, TX
  • NPI 1588997233

  Family Medicine

  Medicare reassignment Care Compare group NPD
• BHS Physicians Network, Inc

  • Family Medicine Physician
  • San Antonio, TX
  • NPI 1598958431
  Medicare reassignment NPD
• BHS Physicians Network, Inc

  • Durable Medical Equipment & Medical Supplies
  • Boerne, TX
  • NPI 1730079286
  NPD
• David P Ellent PLLC

  • Clinical Medical Laboratory
  • Kingwood, TX
  • NPI 1891348959
  NPD
• Seton Family of Doctors

  • Radiology Clinic/Center
  • Austin, TX
  • NPI 1275290694
  NPD
• Seton Family of Doctors

  • Neurological Surgery Physician
  • Kyle, TX
  • NPI 1730412388

  Family Medicine

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Christus Santa Rosa Health Care Corporation

  • General Acute Care Hospital
  • New Braunfels, TX
  • NPI 1114725033
  Care Compare affiliation
• Christus Santa Rosa Health Care Corporation

  • General Acute Care Hospital
  • San Marcos, TX
  • NPI 1447883301
  Care Compare affiliation
• LHCG CXV, LLC

  • Home Health Agency
  • New Braunfels, TX
  • NPI 1588187082
  Care Compare affiliation

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284422400000",
    "number": "1962484733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2108 HUNTER RD",
            "address_2": "SUITE 116",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "786665156",
            "telephone_number": "512-754-7700",
            "fax_number": "512-754-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2108 HUNTER RD",
            "address_2": "SUITE 116",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "786665156",
            "telephone_number": "512-754-7700",
            "fax_number": "512-754-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "JACK",
        "middle_name": "WESLEY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2010-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "G8488",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "TX",
            "license": "G8488",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122902302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores Texas, LP
• Walgreen Co
• Walgreen Co
• Shawn Jeffrey Walker Jr., MD
• Taylor Kiana Wallace, M.S., CCC-SLP
• Mary M Wally, SLP
• Kathryn Nicole Walpole
• Andrew Lee Walsh III, MD
• Derrick Wansom, MD
• Robert L Ward, DO

• Family Medicine Physician in San Marcos, TX
• Providers in San Marcos, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2010; 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.
• 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.