MR. JAMES EDWARD WALLACE JR. (NPI# 1053539783) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053539783 |
| Entity Type | Individual |
| Full Name | MR. JAMES EDWARD WALLACE JR. |
| Credential | PA-C |
| Practice Address |
101 W University Ave Spine and Pain Management Champaign IL 61820-3909 |
| Practice Telephone | 2173668796 |
| Practice Fax Number | 2173666106 |
| Mailing Telephone | 2173661326 |
| Mailing Fax Number | 2173666106 |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2013-09-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 85000087 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083226005 | James D Wallace | Technician | 67 Don Dale Dr, Foster, WV 25081 | 2020-08-20 |
| 1982173571 | James Preston Wallace II | Clinic/Center | 6234 Castlegate Dr W Apt 8112, Castle Rock, CO 80108-8655 | 2018-11-13 |
| 1356686877 | James Steven Wallace | Physical Therapy Assistant | 449 Main St Apt 131, Anderson, IN 46016-1186 | 2012-12-10 |
| 1033400999 | James Wallace | Durable Medical Equipment & Medical Supplies | 593 Bramlett Way, Powder Springs, GA 30127 | 2011-04-27 |
| 1841591559 | James Leeman Wallace | Massage Therapist | 29650 Sw Courtside Dr, #14, Wilsonville, OR 97070-7482 | 2010-11-11 |
| 1992023212 | James Joseph Wallace | Specialist | 154 Sugar Cane Dr, Hartwell, GA 30643-8120 | 2010-05-11 |
| 1538338413 | James Christopher Wallace | Military Health Care Provider | Uss Ross, Ddg 71, Fpo, AE 09586-1288 | 2008-02-26 |
| 1568664274 | James Christopher Wallace | Emergency Medical Technician, Basic | Cgc Chase (whec-718) Fpo Ap 96662-3932 32nd St, San Diego, CA 92106 | 2007-06-04 |
| 1760683924 | James G Wallace Jr. | Family Medicine | 525 Jay Ave, Brewster, WA 98812-3403 | 2007-05-29 |
| 1922143882 | James B Wallace Jr. | Dentist | 6618 Fm 2100, Crosby, TX 77532 | 2007-02-20 |
| Street Address |
101 W UNIVERSITY AVE SPINE AND PAIN MANAGEMENT |
| City | CHAMPAIGN |
| State | IL |
| Zip Code | 61820-3909 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932102969 | Tamara G Helfer | Specialist | 101 W University Ave, Champaign, IL 61820-3981 | 2005-05-23 |
| 1659984540 | Brickston Mellinger | Pharmacist | 101 W University Ave, Champaign, IL 61820-3909 | 2020-08-28 |
| 1477166841 | Amit Patel | Pharmacist | 101 W University Ave, Champaign, IL 61820-3909 | 2020-08-26 |
| 1790320802 | Amy Beth Kutska | Physician Assistant | 101 W University Ave, Champaign, IL 61820-3981 | 2019-11-12 |
| 1093274912 | Alicia Jo Crabtree | Advanced Practice Midwife | 101 W University Ave, Champaign, IL 61820-3981 | 2019-03-19 |
| 1396231767 | Lauren Ashleigh Frerichs | Nurse Practitioner | 101 W University Ave, Champaign, IL 61820-3909 | 2018-07-09 |
| 1700337474 | Annelise Smith | Advanced Practice Midwife | 101 W University Ave, Champaign, IL 61820-3909 | 2016-10-18 |
| 1750836300 | Lindsay Bustle | Advanced Practice Midwife | 101 W University Ave, Champaign, IL 61820-3981 | 2016-08-23 |
| 1922459650 | Kathryn Corgan Mitchell | Physician Assistant | 101 W University Ave, Champaign, IL 61820 | 2016-06-23 |
| 1639572563 | Jacob Backhoff | Pharmacist | 101 W University Ave, Ste 102, Champaign, IL 61820-3909 | 2014-10-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982217345 | Costco Wholesale Corporation | Pharmacy | 2002 N. Neil St., Champaign, IL 61820 | 2020-08-26 |
| 1255963583 | Jamey Richard Bailey | Social Worker | 701 Devonshire Drive, Bldg C, Suite 206, C-6, Champaign, IL 61820 | 2020-02-05 |
| 1790247443 | Jason Abrams | Counselor | 201 W Springfield Ave., Suite 1002-1003, Champaign, IL 61820 | 2019-04-02 |
| 1184100273 | Janine Rafferty | Pharmacist | 2002 N Neil St, Champaign, IL 61820 | 2018-07-12 |
| 1417475070 | Brodbeck Counseling, PC | Community/Behavioral Health | 301 N. Neil Street Suite 323, Champaign, IL 61820 | 2017-09-05 |
| 1447773726 | Quanata M Pelmore | Nurse's Aide | 508 E. Vine St, Champaign, IL 61820 | 2017-07-19 |
| 1821518127 | Molly Mclay | Social Worker | 309 W Clark St., Champaign, IL 61820 | 2017-06-27 |
| 1396265849 | Lou Echols Chambers | Audiologist | 901 South Sixth Street, Chamapign, IL 61820 | 2017-06-26 |
| 1962874495 | Luciana Angelica Guardini | Social Worker | 100 North Chestnut Street, Suite 244, Champaign, IL 61820 | 2015-10-23 |
| 1538544465 | Cpo Services, Inc. | Prosthetic/Orthotic Supplier | 410 E University Ave Ste 105, Champaign, IL 61820 | 2015-07-21 |
| Find all providers in zip 61820 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992134241 | Heather Michelle Nobles | Physician Assistant | 2408 Heathrow Dr, Apartment 14, Champaign, IL 61820-2385 | 2013-11-07 |
| 1720066251 | Heather Konzelmann | Physician Assistant | 1801 Windsor Rd, Champaign, IL 61822-6217 | 2006-01-05 |
| 1598752628 | Kori L Carroll | Physician Assistant | 3105 Fields South Dr, Champaign, IL 61822-3743 | 2005-10-04 |
| 1376544585 | Brian Neal Shore | Physician Assistant | 2110 Fox Dr, Champaign, IL 61820-7553 | 2005-08-10 |
| 1376166264 | Carlos Rodolfo Bocanegra Cordova | Physician Assistant | 819 Bloomington Rd, Champaign, IL 61820-2101 | 2020-05-26 |
| 1992324941 | Ryan Jordan Minier | Physician Assistant | 819 Bloomington Rd, Champaign, IL 61820-2101 | 2020-04-10 |
| 1720619232 | Jacob Blasingame | Physician Assistant | 2300 S 1st St, Champaign, IL 61820-7661 | 2020-02-03 |
| 1790320802 | Amy Beth Kutska | Physician Assistant | 101 W University Ave, Champaign, IL 61820-3981 | 2019-11-12 |
| 1316592637 | Carrie Elizabeth Keenan | Physician Assistant | 819 Bloomington Rd, Champaign, IL 61820-2101 | 2019-08-04 |
| 1093283954 | River Andres | Physician Assistant | 819 Bloomington Rd, Champaign, IL 61820-2101 | 2018-11-08 |
| Find all providers in CHAMPAIGN | ||||
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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.