Raymond B Wallace
Emergency Medicine

Address: 111 E Wisconsin Ave, Suite 2000, Milwaukee, WI 53202-4815
Phone: 4142906720

Raymond B Wallace (NPI# 1437181153) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1437181153
Entity Type Individual
Full Name Raymond B Wallace
Credential D.O.
Gender Male
Practice Address 111 E Wisconsin Ave
Suite 2000
Milwaukee
WI 53202-4815
Practice Telephone 4142906720
Practice Fax Number 4142906755
Mailing Address 1700 Coral Dr
Ste A
Waukesha
WI 53186-1483
Sole Proprietor No, this individual is not a Sole Proprietor
Enumeration Date 2006-07-06
Last Update Date 2016-09-26

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 207P00000X Emergency Medicine Allopathic & Osteopathic Physicians 44478-021 WI

Other Provider Identifier

State Identifier Issuer Type Code
WI 43500600 MEDICAID
WI 930122235 OTHER MEDICARE RAILROAD

Other Providers RAYMOND WALLACE

NPI Name Taxonomy Address Enumeration
1568821874 Raymond Wallace IIi Licensed Vocational Nurse 23861 South Robin Rd, Mandeville, LA 70448 2016-02-15

Physician Overview

NPI 1437181153
PAC ID by PECOS 8921161001
Professional Enrollment ID I20180102000337
Full Name Raymond B Wallace
Organization Legal Name DHHS IHS PHOENIX AREA
Phone Number 9286692137
Gender M
Medical School MID WEST MEDICAL COLLEGE
Graduation Year 1994
Primary Specialty EMERGENCY MEDICINE
Group Practice PAC ID 0244405629
Number of Group Practice Members 13
Accepts Medicare Assignment Y
Report Quality Measures Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
031307 PARKER INDIAN HEALTH CENTER
031317 LA PAZ REGIONAL HOSPITAL

Individual EP (Eligible Professionals) Public Reporting – Performance Scores
Physician Quality Reporting System (PQRS) and non-PQRS Qualified Clinical Data Registry (QCDR)

Measure Identifier Measure Title Performance Rate Reporting Mechanism
PQRS_EP_130_1 Documentation of Current Medications in the Medical Record 100%

Office Location

Street Address 111 E WISCONSIN AVE
SUITE 2000
City MILWAUKEE
State WI
Zip Code 53202-4815

Providers in the same location

NPI Name Taxonomy Address Enumeration
1174593487 Hector G Aguilera Emergency Medicine 111 E Wisconsin Ave, Suite 2000, Milwaukee, WI 53202-4815 2006-01-26
1215460563 Carlos Salez Nurse Anesthetist, Certified Registered 111 E Wisconsin Ave, Suite 2000, Milwaukee, WI 53202-4815 2017-04-04
1952848343 Andrea S. Bond Nurse Anesthetist, Certified Registered 111 E Wisconsin Ave, Suite 2000, Milwaukee, WI 53202-4815 2017-01-24
1821547340 Lisa Alaine Colaluca Physician Assistant 111 E Wisconsin Ave, Suite 2000, Milwaukee, WI 53202-4815 2016-09-26
1700239597 Luke Kosta Miskov Physician Assistant 111 E Wisconsin Ave, Suite 2000, Milwaukee, WI 53202-4815 2016-07-18
1346690872 Charlotte L Dickson Physician Assistant 111 E Wisconsin Ave, Suite 2000, Milwaukee, WI 53202-4815 2016-06-15
1477926202 Ayobami A Adelayi Nurse Anesthetist, Certified Registered 111 E Wisconsin Ave, Suite 2000, Milwaukee, WI 53202-4815 2015-11-02
1235506015 Kayla J Vogds Physician Assistant 111 E Wisconsin Ave, Suite 2000, Milwaukee, WI 53202-4815 2015-08-27
1538536800 Saul Hernandez, Jr. Physician Assistant 111 E Wisconsin Ave, Suite 2000, Milwaukee, WI 53202-4815 2015-08-21
1073996997 Laura E Rodda Physician Assistant 111 E Wisconsin Ave, Suite 2000, Milwaukee, WI 53202-4815 2015-07-09
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1568921278 Sword Health Inc Physical Therapist 1020 North Broadway, Milwaukee, WI 53202 2019-03-13
1619446408 First Priority Home Care, LLC Home Health 342 W. Water Street, Suite 600, Milwaukee, WI 53202 2018-11-21
1346747169 Creative Counseling of Milwaukee Counselor 2266 E Prospect Ave, Suite 304, Milwaukee, WI 53202 2018-04-09
1679095061 Sadaf Hussain Dentist 205 E Wisconsin Ave, Milwaukee, WI 53202 2017-07-07
1437572831 Pathfinder Medical Group Family Medicine 216 Milwaukee St, Suite 2d, Milwaukee, WI 53202 2014-01-22
1669819785 Kate Savage Anzia Counselor 2266 North Prospect Avenue, Suite 326, Ravenswood Clinic, Milwaukee, WI 53202 2013-05-30
1164773222 Rutell Counseling Services, L.l.c. Counselor 759 N. Milwaukee St., Suite 600, Milwaukee, WI 53202 2012-09-28
1548563760 Susan Rose Westergren Pharmacist 1400 E. Brady St, Walgreens, Milwaukee, WI 53202 2010-12-09
1174848816 Brian D Eiche Emergency Medicine 111 E. Wisconsin Ave. Ste 2100, Infinity Healthcare, Milwaukee, WI 53202 2010-04-06
1356591978 Randle E Pollard Urology 1233 N. Marshall St., #274, Milwaukee, WI 53202 2008-09-19
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Taxonomy Information

Taxonomy Code 207P00000X
Grouping Allopathic & Osteopathic Physicians
Classification Emergency Medicine

Taxonomy Definition

An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source]
- Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1811384464 Megan O Bedolla Emergency Medicine 2338 E Ohio Ave, Milwaukee, WI 53207 2015-04-21
1174848816 Brian D Eiche Emergency Medicine 111 E. Wisconsin Ave. Ste 2100, Infinity Healthcare, Milwaukee, WI 53202 2010-04-06
1285963116 Randall Levin Emergency Medicine 201 W Bergen Dr, Milwaukee, WI 53217-2308 2009-12-24
1003935925 Andrea Michelle Kraus Emergency Medicine 3237 S 16th St Ste 100, Milwaukee, WI 53215-4526 2007-03-29
1427147990 Nancy L. Dovin Emergency Medicine 2104 N Hi Mount Blvd, Milwaukee, WI 53208-1111 2006-10-12
1750304283 Kimberly A Ridl Emergency Medicine 4500 National Ave, Milwaukee, WI 53295-0001 2006-07-25
1821013277 Gail Hendley Emergency Medicine 500 W Chambers St, Milwaukee, WI 53212-2308 2006-07-13
1356396840 Kelly Hedlund Kanter Emergency Medicine 111 E Wisconsin Avenue, Milwaukee, WI 53202-4815 2006-05-23
1902855950 Infinity Healthcare Physicians, S.c. Emergency Medicine 2025 East Newport Avenue, Columbia St Mary's Columbia Campus, Milwaukee, WI 53211-2906 2006-05-08
1588612170 James David Erickson Emergency Medicine 111 E Wisconsin Ave Ste 2000, Milwaukee, WI 53202-4809 2006-05-05
Find all providers in MILWAUKEE

Competitor

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City MILWAUKEE
Zip Code 53202

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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