DR. GREGORY WALLIS (DO) – Emergency Medicine Physician, NPI 1790308278
Emergency Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,206 EMERGENCY MEDICINE in WA
Provider Addresses for DR. GREGORY WALLIS (DO)
PO BOX 95461
CLEVELAND, OH 441010033
Phone: (928) 669-2137
Type: Mailing
835 SE BISHOP BLVD
PULLMAN, WA 991635512
Phone: (509) 332-2541
Type: Location
12033 Agency Rd
Parker, AZ 853447718
Phone: (289) 669-2137
Type: Location
1031 MCINTOSH CIR
JOPLIN, MO 648043643
Phone: (801) 455-5078
Fax: (437) 537-5094
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-03-31
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20220412001068 | I | Emergency Medicine | MO | TBD |
| I20230711003079 | I | Emergency Medicine | WA | TBD |
| I20250331001867 | I | Emergency Medicine | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 44101)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | SD | |
| Diagnostic Radiology | TX | |
| Emergency Medicine | CA | |
| - | CA | |
| Family Practice | KS | |
| Emergency Medicine | IN | |
| - | GA | |
| Emergency Medicine, Family Practice | AZ | |
| Emergency Medicine | WI | |
| Internal Medicine | CA |
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