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IAN WILLIAM WALLIS MD
NPI 1053251348
Student in an Organized Health Care Education/Training Program in Rochester, NY

Active since March 30, 2026PECOS Enrolled
601 ELMWOOD AVENUE BOX 655, ROCHESTER, NY 14642(585) 756-4800 Get Directions Write a Review

NPPES record last updated: March 30, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Ian William Wallis Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IAN WILLIAM WALLIS MD (NPI 1053251348) is an individual student in an organized health care education/training program in Rochester, New York and active in the NPI registry since March 2026. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053251348
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameIAN WILLIAM WALLISCredential: MD
Location Address601 ELMWOOD AVENUE BOX 655Rochester, NY 14642-0001
Mailing Address601 Elmwood Avenue Box 655Rochester, NY 14642-0001
Phone(585) 756-4800
Sole ProprietorNo
Enumeration DateMarch 30, 2026
NPPES CertifiedMarch 29, 2026
✔ NPI 1053251348 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
601 ELMWOOD AVENUE BOX 655, Rochester, NY 14642
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ian William Wallis Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MARLON RODRIGUEZ MD
Student in an Organized Health Care Education/Training Program
601 ELMWOOD AVENUE BOX 655
ROCHESTER, NY 14642
Monroe County (585) 756-4800
BRIANNA KINLEY MD
Student in an Organized Health Care Education/Training Program
601 ELMWOOD AVENUE BOX 655
ROCHESTER, NY 14642
Monroe County (585) 756-4800
REBEKAH HANS SWT
Student in an Organized Health Care Education/Training Program
601 ELMWOOD AVENUE BOX 655
ROCHESTER, NY 14642
Monroe County (585) 756-4800
ABU- MUTTALIB LATIF DO
Student in an Organized Health Care Education/Training Program
601 ELMWOOD AVENUE BOX 655
ROCHESTER, NY 14642
Monroe County (585) 276-3000
CHELLISE KEMIS DO
Student in an Organized Health Care Education/Training Program
601 ELMWOOD AVENUE BOX 655
ROCHESTER, NY 14642
Monroe County (585) 756-4800
CLAY THOMAS BARON
Student in an Organized Health Care Education/Training Program
601 ELMWOOD AVENUE BOX 655
ROCHESTER, NY 14642
Monroe County (585) 756-4800
CHRISTINE DOMINAS MD
Student in an Organized Health Care Education/Training Program
601 ELMWOOD AVENUE BOX 655
ROCHESTER, NY 14642
Monroe County (585) 236-9772
DR. SAMUEL DEAN BLACK MD
Student in an Organized Health Care Education/Training Program
601 ELMWOOD AVENUE BOX 655
ROCHESTER, NY 14642
Monroe County (585) 756-4800

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ian Wallis's NPI number?

The NPI number for Ian Wallis is 1053251348. It was assigned to this individual provider in the NPPES registry on March 30, 2026.

Where is Ian Wallis located?

Ian Wallis practices at 601 Elmwood Avenue Box 655, Rochester, NY 14642. The listed phone number is (585) 756-4800.

What is Ian Wallis's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Ian Wallis enrolled in Medicare?

Yes. Ian Wallis is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Ian Wallis was last updated on March 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.