Active NPI
Danyale A Wallace, M.D.
- Emergency Medicine Physician
- Chicago, IL
National Provider Identifier
1992826358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 336076552
- Practice address
- 1901 W Polk Street
Floor 10
Chicago, IL 60612 - Phone
- (312) 964-0060
- NPI assigned
- Apr 3, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 336076552 | IL | Primary |
Addresses
Primary practice location
1901 W Polk Street
Floor 10
Chicago, IL 60612
Mailing address
300 W North Ave
Apt. 302
Chicago, IL 60610-1248
Phone (312) 274-9694
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 217008 | Other | MEDICARE GROUP # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR, MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- Rush Medical College of Rush University, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1710 Harrison St Slot
24 White River Emergency Physicians
Batesville, AR 72501-7303
Phone (870) 262-1240
Hospital & facility affiliations
- White River Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 336076552 | IL | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| White River Health System, Inc | Emergency Medicine | Current | Accepting new patients |
| White County Medical Center | Current | Accepting new patients | |
| White County Medical Center | Emergency Medicine | Current | Accepting new patients |
Locations
1710 Harrison St
Batesville, AR 72501
Phone (870) 262-1240
1710 Harrison St
#24
Batesville, AR 72501
Phone (870) 262-1240
3214 E Race Ave
Searcy, AR 72143
Phone (501) 268-6121
Organizations & group practices 4
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.
-
- Emergency Medicine Physician
- Batesville, AR
- NPI 1578872297
-
- Emergency Medicine Physician
- Searcy, AR
- NPI 1437359742
-
- Emergency Medicine Physician
- Maysville, KY
- NPI 1356379382
AR, MS
-
- Obstetrics & Gynecology Physician
- Newport, AR
- NPI 1740940220
Hospital & facility affiliations 16
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Orthopaedic Surgery Physician
- Batesville, AR
- NPI 1265821193
Hospital
-
- Pain Medicine (Anesthesiology) Physician
- Batesville, AR
- NPI 1558447599
Hospital
-
- General Acute Care Hospital
- Batesville, AR
- NPI 1710943881
-
- Hematology & Oncology Physician
- Batesville, AR
- NPI 1760779607
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225238400000",
"number": "1992826358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W NORTH AVE",
"address_2": "APT. 302",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606101248",
"telephone_number": "312-274-9694"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 W POLK STREET",
"address_2": "FLOOR 10",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60612",
"telephone_number": "312-964-0060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DANYALE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-03",
"last_updated": "2008-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IL",
"license": "336076552",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP #",
"identifier": "217008",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2008; 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.