Ken Carlson Walls, PHD, MPAS, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

PTL1723 Issued in CA

Practice address

10800 Magnolia Ave
Riverside, CA 92505-3043

Phone

(951) 353-2000

NPI assigned

Jan 18, 2016

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 2

Electronic endpoints 1

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

Specialty

Physician Assistant

Education

Lake Erie College of Osteopathic Medicine, Erie, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of RiversideGroup PAC ID 6507754488, 190 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Riverside University Health System-Medical Center Hospital, Moreno Valley, CA, CCN 050292

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Physician Assistant, Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kwalls305801@direct.llu.edu

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.

• County of Riverside

  • Federally Qualified Health Center (FQHC)
  • Indio, CA
  • NPI 1023122967

  Single Specialty

  Medicare reassignment Care Compare group NPD
• County of Riverside

  • Federally Qualified Health Center (FQHC)
  • Jurupa Valley, CA
  • NPI 1871607713
  NPD
• County of Riverside

  • Clinical Medical Laboratory
  • Riverside, CA
  • NPI 1952496010
  NPD

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

• County of Riverside

  • General Acute Care Hospital
  • Moreno Valley, CA
  • NPI 1821159195
  Care Compare affiliation

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

{
    "created_epoch": "1453075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1992162242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12143 DEWAR DR",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925054106",
            "telephone_number": "314-488-5943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053043",
            "telephone_number": "951-353-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "26520 Cactus Ave",
            "address_purpose": "LOCATION",
            "city": "Moreno Valley",
            "state": "CA",
            "postal_code": "925553927",
            "country_code": "US",
            "telephone_number": "951-486-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2036 S 5th St",
            "address_2": "Apt 12",
            "address_purpose": "LOCATION",
            "city": "McAllen",
            "state": "TX",
            "postal_code": "785032938",
            "country_code": "US",
            "telephone_number": "314-488-5943",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLS",
        "first_name": "KEN",
        "middle_name": "CARLSON",
        "name_prefix": "Dr.",
        "credential": "PHD, MPAS, DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-01-18",
        "last_updated": "2023-09-26",
        "certification_date": "2020-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "PTL1723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992162242",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992162242",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Megan Wallace, M.S., C.C.C-SLP
• Susan Victoria Wallace, CLINICIAN
• Tammi Wallace
• Chris Eric Waller
• Andrew Michael Wallin
• Britt E Wallstrom, OT
• Walmart
• Walmart
• Walmart Inc.
• Walmart Inc.

• Internal Medicine Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.