RICHARD G WALLIS MD PA (NPI# 1801169412) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801169412 |
| Entity Type | Organization |
| Organization Name | RICHARD G WALLIS MD PA |
| Practice Address |
1 Shircliff Way Jacksonville FL 32204-4748 |
| Mailing Address |
6255 Lake Gray Blvd Suite 1 Jacksonville FL 32244-7502 |
| Practice Telephone | 9044212119 |
| Enumeration Date | 2012-02-13 |
| Last Update Date | 2012-02-13 |
| Authorized Official Name | RICHARD WALLIS (PRESIDENT) |
| Authorized Official Telephone | 9044212119 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207L00000X | Anesthesiology | ME37752 | FL | Allopathic & Osteopathic Physicians |
| Street Address |
1 SHIRCLIFF WAY |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32204-4748 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295738367 | Emergency Medical Specialists of Jacksonville | Emergency Medicine | 1 Shircliff Way, Jacksonville, FL 32204-4778 | 2005-05-23 |
| 1033725858 | Kathleen Fry | Registered Nurse | 1 Shircliff Way, Jacksonville, FL 32204-4748 | 2020-09-17 |
| 1841808912 | Jade Leanne Nelson Donegal | Registered Nurse | 1 Shircliff Way, Jacksonville, FL 32204-4748 | 2020-07-15 |
| 1124642731 | Arielle Christina Griffin | Social Worker | 1 Shircliff Way, Jacksonville, FL 32204-4748 | 2020-05-31 |
| 1639709199 | Tom Wonneberger | Physician Assistant | 1 Shircliff Way, Jacksonville, FL 32204-4748 | 2020-01-23 |
| 1114557162 | Janet Marie Goodson | Registered Nurse | 1 Shircliff Way, Jacksonville, FL 32204-4748 | 2020-01-17 |
| 1487291472 | Megan Elaine Karbowski | Anesthesiologist Assistant | 1 Shircliff Way, Jacksonville, FL 32204-4748 | 2019-12-09 |
| 1124663182 | Douglas Earl Stilwell | Nurse Practitioner | 1 Shircliff Way, Jacksonville, FL 32204-4748 | 2019-11-14 |
| 1316588908 | Andrew Griffin | Anesthesiologist Assistant | 1 Shircliff Way, Jacksonville, FL 32204-4748 | 2019-10-04 |
| 1194366278 | Laura Ann Kereczman | Nurse Practitioner | 1 Shircliff Way, Jacksonville, FL 32204-4748 | 2019-09-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437719853 | North Florida Surgeons, Pa | Orthopaedic Surgery | 2 Shirlciff Ways, Suite 300, Jacksonville, FL 32204 | 2019-06-18 |
| 1770043531 | Manuel Viado Rosas | Physical Therapist | Bold City Therapy and Wellness LLC, 2054 Park Street, Jacksonville, FL 32204 | 2019-03-20 |
| 1255805172 | Tracie Nickole Singh | Marriage & Family Therapist | 1125 W Beaver Street, Suite 205, Jacksonville, FL 32204 | 2019-01-14 |
| 1427548544 | Bold City Therapy and Wellness LLC | Clinic/Center | 2054 Park Street, Jacksonville, FL 32204 | 2018-05-14 |
| 1356883078 | Lcn Enterprise, LLC | Case Manager/Care Coordinator | 1225 W Beaver St Ste 106, Jacksonville, FL 32204 | 2016-11-11 |
| 1073065082 | Prosser and Prosser LLC | Non-emergency Medical Transport (VAN) | 2120 Ernest St, Jacksonville, FL 32204 | 2016-10-26 |
| 1336529817 | Nader Daoud | Internal Medicine | 1 Shircliffway, Jacksonville, FL 32204 | 2015-06-01 |
| 1194119214 | Benjamin James Dionne | Internal Medicine | 2 Shircliff Way Ste 400, Jacksonville, FL 32204 | 2015-03-26 |
| 1598187932 | Jamara Stephens | Counselor | 1225 W Beaver St Ste 205, Jacksonville, FL 32204 | 2014-01-18 |
| 1154743961 | Kathleen Jasper | Nurse Anesthetist, Certified Registered | 2165 Herschel Street, Jacksonville, FL 32204 | 2014-01-14 |
| Find all providers in zip 32204 | ||||
| Taxonomy Code | 207L00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation or an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during and after surgery. In addition to these management responsibilities, the anesthesiologist provides medical management and consultation in pain management and critical care medicine. Anesthesiologists diagnose and treat acute, long-standing and cancer pain problems; diagnose and treat patients with critical illnesses or severe injuries; direct resuscitation in the care of patients with cardiac or respiratory emergencies, including the need for artificial ventilation; and supervise post-anesthesia recovery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Anesthesiology, 2007. http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487203451 | Brittany Clark | Anesthesiology | 220 Riverside Ave Unit 328, Jacksonville, FL 32202-4953 | 2019-09-11 |
| 1093240061 | Beric Emilio Berlioz | Anesthesiology | 4500 San Pablo Rd S # J, Jacksonville, FL 32224 | 2017-04-26 |
| 1699223453 | James Dennis Beeson | Anesthesiology | 9289 Rosewater Lane, Jacksonville, FL 32256 | 2016-09-21 |
| 1598129314 | Kaitlin Kamrowski | Anesthesiology | 653 West 8th Street, Faculty Clinic Building, 3rd Floor, Box Fc-12, Jacksonville, FL 32209 | 2016-04-07 |
| 1487017786 | Guy Kositratna | Anesthesiology | 653 West 8th Street, Jacksonville, FL 32209-6511 | 2016-04-04 |
| 1942603899 | Pain Medicine Physicians of Jacksonville, LLC | Anesthesiology | 10250 Normandy Boulevard, Suite 702, Jacksonville, FL 32221 | 2014-10-07 |
| 1063707784 | Chase Alan Kissling | Anesthesiology | Attn: Dmhrsi Team Bldg H 2005 Knight Lane, Navy Medicine Support Command, Jacksonville, FL 32212-0140 | 2011-06-10 |
| 1770804916 | Michael George Zakaroff | Anesthesiology | 2005 Knight Lane Bldh H, Navy Medicine Support Command Attn: Medical Staff Servi, Jacksonville, FL 32212-0140 | 2010-06-22 |
| 1427283522 | Darryl Crosswright Hall | Anesthesiology | 653 W. Eighth St., Faculty Clinic 3rd Floor, Jacksonville, FL 32209 | 2009-05-19 |
| 1578707071 | Puja Roy | Anesthesiology | 8268 Ashworth Ct, Jacksonville, FL 32256-3638 | 2009-04-28 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32204 |
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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.