Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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John Mathew Wallace, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1699489484

John Mathew Wallace, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Winston Salem, North Carolina. Qualified in 2022, 4 years ago. Practices with Medical Park Hospital LLC, a 109-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
4
Licensed in
NC
In the registry since
2023
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

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Practice location Address checks out

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone: (336) 718-5000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 7073 (NC)

Record details

NPI number1699489484
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNA
Sole proprietorYes
NPI enumeratedJanuary 6, 2023
Last updated in NPPESJanuary 6, 2023
Certification dateJanuary 6, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Medical Park Hospital Llc — 109 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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