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DR. ADAM N WALLACE MD NPI 1801117585


NPI Information

NPI: 1801117585
Provider Name: DR. ADAM N WALLACE, MD
Classification: Radiology - 2085N0700X
Entity Type: Individual

Specialization: Neuroradiology

PECOS Registration: Yes

Address:
8201 EAST RIVERSIDE BOULEVARD
MERCY HEALTH JAVON BAE HOSPITAL
ROCKFORD, IL
ZIP 61114
Phone: (815) 971-5000
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DR. Adam N Wallace, MD is a neuroradiology radiology in Rockford, IL with 14 years of experience. The provider is a radiologist who diagnoses and treats diseases utilizing imaging procedures as they relate to the brain, spine and spinal cord, head, neck and organs of special sense in adults and children. DR. Adam N Wallace, MD NPI is 1801117585. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduation Year:2010

The provider's business location address is:

8201 EAST RIVERSIDE BOULEVARD
MERCY HEALTH JAVON BAE HOSPITAL
ROCKFORD, IL
ZIP 61114-300
Phone: (815) 971-5000

The NPI 1801117585 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Ultrasound guidance for accessing into blood vessel (HCPCS:76937)
  • Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes (HCPCS:99152)

The enumeration date for this NPI number is 6/17/2010 and was last updated on 12/15/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12085N0700XRadiologyNeuroradiology70505-20WISCONSINNo
22085N0700XRadiologyNeuroradiology61898MINNESOTANo
32085R0202XRadiologyDiagnostic RadiologyDR.0068906COLORADONo
42085R0202XRadiologyDiagnostic Radiology2015013114MISSOURINo
52085R0202XRadiologyDiagnostic Radiology319983NEW YORKNo
62085R0202XRadiologyDiagnostic Radiology036.148822ILLINOISNo
72085N0700XRadiologyNeuroradiology036.148822ILLINOISYes
82084N0400XPsychiatry & NeurologyNeurology70505WISCONSINNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1200021565MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.