Carly M Wallis, M.S., RPA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50005259RX Issued in OH

Practice address

817 Forest Ave
Zanesville, OH 43701-2820

Phone

(740) 454-7546

NPI assigned

Oct 4, 2009

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

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Center for Surgical Dermatology IncGroup PAC ID 9739087602, 33 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mount Carmel East & West Hospital, Columbus, OH, CCN 360035
• Licking Memorial Hospital Hospital, Newark, OH, CCN 360218

Merit-based Incentive Payment System (MIPS)

Final score

83.85 of 100Reported as group

Promoting interoperability

81

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carly.wallis@qdp.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.

• Center for Surgical Dermatology Inc

  • Dermatology Physician
  • Westerville, OH
  • NPI 1972532091
  Medicare reassignment Care Compare group
• Sanctuary Medical Aesthetic Center of Boca Raton LLC

  • Dermatology Physician
  • Boca Raton, FL
  • NPI 1104282714
  NPD
• CSD ASC LLC

  • Ambulatory Surgical Clinic/Center
  • Westerville, OH
  • NPI 1821159823
  NPD (past)

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

• Licking Memorial Hospital

  • General Acute Care Hospital
  • Newark, OH
  • NPI 1568446755
  Care Compare affiliation
• Mount Carmel Health System

  • General Acute Care Hospital
  • Grove City, OH
  • NPI 1710067376
  Care Compare affiliation
• Mount Carmel Health System

  • General Acute Care Hospital
  • Columbus, OH
  • NPI 1982784534
  Care Compare affiliation

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

{
    "created_epoch": "1254614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1992030316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 FOREST AVE",
            "city": "ZANESVILLE",
            "state": "OH",
            "postal_code": "437012820",
            "telephone_number": "740-454-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 FOREST AVE",
            "city": "ZANESVILLE",
            "state": "OH",
            "postal_code": "437012820",
            "telephone_number": "740-454-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "CARLY",
        "middle_name": "M",
        "credential": "M.S., RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-04",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50005259RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liesta R Walker, P.C.
• Suzette Walker
• Tamara M Walker, LISW-S
• Brennen Wallace
• Tiffany Marie Wallace
• William Robert Christopher Wallis, OD
• Dauntrica Michele Wallstrum, PMHNP
• Shannon Walters, CDCA
• Miranda Danielle Walton, MA, LPCC-S
• Alexis Y Wang, DDS

• Physician Assistant in Zanesville, OH
• Providers in Zanesville, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; 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.