DR. ERIC D WALLISA (NPI# 1255309720) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255309720 |
| Entity Type | Individual |
| Full Name | DR. ERIC D WALLISA |
| Credential | M.D. |
| Practice Address |
5955 S Emerson Ave 100 Indianapolis IN 46237-2525 |
| Practice Telephone | 3177899600 |
| Practice Fax Number | 3177890600 |
| Mailing Telephone | 3177899600 |
| Mailing Fax Number | 3177890600 |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2009-12-31 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 01054688A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA NUMBER | BW8186492 | 01 | |
| IN | STATE CSR | 01054688B | 01 |
| IN | STATE MEDICAL LICENSE | 01054688A | 01 |
| Street Address |
5955 S EMERSON AVE 100 |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46237-2525 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023086725 | Rhonda Goul | Family Medicine | 5955 S Emerson Ave, Suite 100, Indianapolis, IN 46237-2525 | 2006-03-09 |
| 1144574070 | Cathy Yoder Md, LLC | Family Medicine | 5955 S Emerson Ave, Suite 100, Indianapolis, IN 46237-2600 | 2012-10-30 |
| 1386868156 | Wilbur Eugene Roberts | Dentist | 5955 S Emerson Ave, Ste. 200, Indianapolis, IN 46237-2600 | 2007-04-12 |
| 1164588802 | Jeffery A Roberts | Dentist | 5955 S Emerson Ave, Ste. 200, Indianapolis, IN 46237-2600 | 2006-12-28 |
| 1215024674 | Southside Family Medical Group, LLC | Family Medicine | 5955 S Emerson Ave, Suite 100, Indianapolis, IN 46237-2600 | 2006-10-06 |
| 1164490538 | David D Williams | Family Medicine | 5955 S Emerson Ave, Suite 100, Indianapolis, IN 46237-2525 | 2006-03-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568961902 | Ashley Marie Mitchell | Nurse Practitioner | 8111 S Emerson Ave # 101, Indianapolis, IN 46237 | 2018-02-11 |
| 1245692177 | Christopher W Gregory | Pharmacist | 8111 S Emerson Avenue, Indianapolis, IN 46237 | 2016-03-21 |
| 1558729111 | Franklin Point Dental | Clinic/Center | 6751 E Southport Rd, Suite H, Indianapolis, IN 46237 | 2016-02-10 |
| 1821460767 | Costco Wholesale Corporation | Pharmacy | 4628 E County Line Rd, Indianapolis, IN 46237 | 2015-10-29 |
| 1164894697 | Mercedes Castellanos-pitcock | Physician Assistant | 7855 S Emerson Ave Ste P, Indianapolis, IN 46237 | 2015-10-23 |
| 1013301142 | Sophia Frawley | Physical Therapist | 7855 South Emerson Avenue, Suite W, Indianepolis, IN 46237 | 2015-03-26 |
| 1154715829 | Emily Marie Prather | Specialist/Technologist | 4607 Citation Cir, Indianapolis, IN 46237 | 2015-03-20 |
| 1659794543 | Rachel Adams | Occupational Therapy Assistant | 6525 Moss Creek Place, Indianapolis, IN 46237 | 2014-01-28 |
| 1790121549 | Carol Lynn Patton | Nurse Practitioner | 8111 S Emerson Ave Fl 5, Indianapolis, IN 46237 | 2013-05-21 |
| 1255685772 | Jarron J Lincoln | Physician Assistant | 5230 E Stop 11 Rd Ste 250, Indianapolis, IN 46237 | 2012-11-06 |
| Find all providers in zip 46237 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073125225 | Relymd Medical Group In, LLC | Family Medicine | 9221 Crawfordsville Rd, Indianapolis, IN 46234-1521 | 2020-08-19 |
| 1134765993 | Basil Vareldzis | Family Medicine | 9125 Nautical Watch Dr, Indianapolis, IN 46236-9036 | 2019-11-26 |
| 1366084329 | Rebekah Venable | Family Medicine | 5455 W 86th St Ste 210, Indianapolis, IN 46268-1530 | 2019-10-11 |
| 1710455738 | Physicians Wellness Associates LLC | Family Medicine | 4735 Statesmen Drive, Suite C, Indianapolis, IN 46250 | 2018-11-07 |
| 1386150043 | Brengle Family Medicine | Family Medicine | 8803 N Meridian St Ste 350, Indianapolis, IN 46260-5386 | 2017-12-18 |
| 1164937249 | Amy Cheung | Family Medicine | 6484 N Chester Ave, Indianapolis, IN 46220-4422 | 2017-12-11 |
| 1578017182 | Medical Specialty LLC | Family Medicine | 2301 N Meridian St, Indianapolis, IN 46208-5729 | 2016-08-11 |
| 1245685742 | Christopher Basom | Family Medicine | 8501 E 56th St Ste 120, Indianapolis, IN 46216-2118 | 2016-05-03 |
| 1760846877 | Catherine Gambale Trigonis | Family Medicine | 404 E Washington St Ste A, Indianapolis, IN 46204 | 2016-04-06 |
| 1205204203 | Community Health Network | Family Medicine | 1643 E Hanna Ave, Ste 108, Indianapolis, IN 46227-3655 | 2015-09-08 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46237 |
Please comment or provide details below to improve the information on DR. ERIC D WALLISA.
| 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.