DONALD R. WALLACE M.D.
NPI 1700899788
Emergency Medicine in Peoria, IL

Q: What is Donald Wallace's NPI number?

The NPI number for Donald Wallace is 1700899788. It was assigned to this individual provider in the NPPES registry on August 14, 2006.

Q: What is Donald Wallace's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Q: When was this NPI record last updated?

The NPPES record for Donald Wallace was last updated on July 29, 2010. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since August 14, 2006PECOS Enrolled

5114 N GLEN PARK PLACE RD, PEORIA, IL 61614(309) 683-6600 Get Directions Write a Review

NPPES record last updated: July 29, 2010. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Donald R. Wallace M.d. NPPES

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

DONALD R. WALLACE M.D. (NPI 1700899788) is an individual emergency medicine provider in Peoria, Illinois, licensed in Illinois (036-077680) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1700899788

Entity TypeIndividualMale

Primary Taxonomy207P00000X

Provider Legal NameDONALD R. WALLACECredential: M.D.

Location Address5114 N GLEN PARK PLACE RDPeoria, IL 61614-4686

Mailing Address5114 N Glen Park Place RdPeoria, IL 61614-4686 · (309) 683-6600

Phone(309) 683-6600

Sole ProprietorNo

Enumeration DateAugust 14, 2006

Last NPPES UpdateJuly 29, 2010

✔ NPI 1700899788 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207P00000X

License✔ Licensed in IL · 036-077680

Definition

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.

5114 N GLEN PARK PLACE RD, Peoria, IL 61614

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Other Identifiers 6

Medicare ID-Type UnspecifiedL19151

Other809840034IL · Medicare Individual Ptan

Medicare UPINC44694

Medicaid036077680IL

Other809840IL · Medicare Group Ptan

Other800810Medicare Group No.

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Donald R. Wallace M.d. 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61614 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$97.25 typical visit price

range $17.16 – $136.56

Typical copayment $24.31 (range $4.29 – $34.14)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.