DONALD R. WALLACE (NPI# 1700899788) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700899788 |
| Entity Type | Individual |
| Full Name | DONALD R. WALLACE |
| Credential | M.D. |
| Practice Address |
5114 N Glen Park Place Rd Peoria IL 61614-4686 |
| Practice Telephone | 3096836600 |
| Mailing Telephone | 3096836600 |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2010-07-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 036-077680 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE GROUP NO. | 800810 | 01 | |
| IL | MEDICARE INDIVIDUAL PTAN | 809840034 | 01 |
| IL | 036077680 | 05 | |
| IL | MEDICARE GROUP PTAN | 809840 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467888537 | Donald W Wallace | Hearing Instrument Specialist | 3 Mid Rivers Mall, Saint Peters, MO 63376-4301 | 2013-09-20 |
| 1295864304 | Donald Mcquire Wallace | Dentist | 3700 Old Forest Rd, Lynchburg, VA 24501-6900 | 2007-03-05 |
| 1891856738 | Donald John Wallace | Chiropractor | 127 Smithtown Blvd Ste 21, Nesconset, NY 11767-1736 | 2006-12-13 |
| 1316983372 | Donald K Wallace | Internal Medicine | 102 Gossman Rd, Southern Pines, NC 28387-2224 | 2006-06-20 |
| 1760944813 | Donald Mckinney Wallace | Behavior Technician | 6701 Democracy Blvd, Bethesda, MD 20817-1572 | 2019-04-05 |
| 1497078893 | Donald D Wallace | Physical Therapist | 605 W State St, First Floor, Media, PA 19063-2620 | 2010-03-12 |
| Street Address |
5114 N GLEN PARK PLACE RD |
| City | PEORIA |
| State | IL |
| Zip Code | 61614-4686 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477533057 | Susan Sphar | Midwife | 5114 N Glen Park Place Rd, Suite 220, Peoria, IL 61614-4686 | 2006-01-19 |
| 1851876593 | Grace Marie Harmon | Physician Assistant | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2018-09-28 |
| 1053801191 | Joy L Meachum | Social Worker | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2018-05-15 |
| 1932607835 | Ashley L Whitlatch | Nurse Practitioner | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2018-01-25 |
| 1417461260 | Michele D. Dudley | Nurse Practitioner | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2017-11-30 |
| 1639681117 | Melissa Renee Garmon | Physician Assistant | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2017-10-24 |
| 1104335546 | Lindsey Spangler | Nurse Practitioner | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2017-09-28 |
| 1295259901 | Laine K Thies | Nurse Practitioner | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2017-08-03 |
| 1083147763 | Jennifer Robison | Nurse Practitioner | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2017-04-10 |
| 1295280303 | Heidi L Gendron | Nurse Practitioner | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2016-08-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548818511 | Christine Svoboda | Social Worker | 6919 N Knoxville Ave Ste 100 and 202, Peoria, IL 61614 | 2019-09-03 |
| 1639649007 | Kathy Karouzos Counseling, LLC | Clinic/Center | 330 W. Ivy Ln., Peoria, IL 61614 | 2018-11-28 |
| 1205312790 | Kathleen Marie Hendricks | Nurse Practitioner | 2809 W Willow Knolls Dr, Peoria, IL 61614 | 2018-07-17 |
| 1629563937 | Mary Elizabeth Cunningham | Counselor | 6219 N. Eldorado Dr., Peoria, IL 61614 | 2018-06-28 |
| 1861937955 | Angela Gilles | Social Worker | 6919 N Knoxville Ave Ste 100, Peoria, IL 61614 | 2016-12-27 |
| 1467994897 | Melissa Saxsma | Specialist | 5009 N Executive Dr, Peoria, IL 61614 | 2016-11-16 |
| 1902258874 | Rashid Plastic Surgery, LLC | Plastic Surgery | 804 W Trailcreek Drive, Peoria, IL 61614 | 2016-07-05 |
| 1215313143 | Melissa Lynn Phelan | Nurse Practitioner | 122 E Morningside Dr, Peoria, IL 61614 | 2015-08-03 |
| 1811380165 | All Ways Caring Services, Inc. | In Home Supportive Care | 6919 N Knoxville Ave, Suite 102, Peoria, IL 61614 | 2015-03-11 |
| 1568875920 | Schuler & Arkwell Orthodontic Partnership | Dentist | 2425 Cornerstone Ct. Ste. A, Peoria, IL 61614 | 2014-06-03 |
| Find all providers in zip 61614 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| 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. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205367802 | Medexpress Urgent Care Illinois, P.C. | Emergency Medicine | 5038 N Big Hollow Road, Peoria, IL 61615-3510 | 2017-03-24 |
| 1285049296 | Julia Hutchison | Emergency Medicine | 530 Ne Glen Oak Ave # Sfnb2624, Peoria, IL 61637-0001 | 2014-06-27 |
| 1891134151 | Kyle Fletcher Brown | Emergency Medicine | Osf Saint Francis Medical Center 530 Ne Glen Oak Ave, North Building 2620, Peoria, IL 61637-0001 | 2013-06-20 |
| 1366673436 | Joseph William Hauter | Emergency Medicine | 830 Ne Glen Oak Ave, Peoria, IL 61637 | 2009-08-06 |
| 1437380748 | Jeremy R Monroe | Emergency Medicine | 530 Glen Oak, Osf St Francis Medical Center, Peoria, IL 61637 | 2009-08-04 |
| 1568624708 | Brandon C Begley | Emergency Medicine | 540 Ne Glen Oak Ave, Peoria, IL 61603 | 2008-06-30 |
| 1114119880 | Suhail Khan | Emergency Medicine | Osf Stfrancis Medical Center Dept of Emergency Medicine, 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2007-08-15 |
| 1962601351 | Tony Yun Hsu | Emergency Medicine | 3517 W Willow Knolls Dr, 1-f, Peoria, IL 61614-1090 | 2007-07-16 |
| 1053518092 | Michael M Raso | Emergency Medicine | 1115 N Bourland Ave, Peoria, IL 61606-1210 | 2007-07-02 |
| 1184670663 | Methodist Medical Center of Illinois | Emergency Medicine | 120 Ne Glen Oak Ave, Suite 101, Peoria, IL 61603 | 2006-05-26 |
| Find all providers in PEORIA | ||||
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| 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.