Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1821551334 Individual Practitioner Female Practitioner

Dr. Elizabeth Nicole Wallis , MD

Pediatrics • Bloomington, IL

Professional Overview & Biography Verified Profile Summary

Dr. Elizabeth Wallis, MD is a registered healthcare professional specializing in Pediatrics in Bloomington, IL. Practice services are available at 200 W MONROE ST STE 302 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

200 W Monroe St Ste 302

Bloomington, IL 617013997

Telephone 3092046766

Specialty Benchmarks & Practice Insights

Comparative analytics for Pediatrics in Bloomington, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 31.5 Yrs
State Avg: 21.7 Yrs
Regional Practice Density
14 Specialists

Practicing in Bloomington, IL (3277 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-08-03
Pediatrics Primary Specialty

NUCC Taxonomy Code: 208000000X

State License LA 331615

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Pediatrics

NUCC Taxonomy Code: 208000000X

State License IL 036.176418

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners
Dr. Paul Flores , PhD

Psychologist - Clinical

NPI 1124713292

Doctor of Philosophy (Ph.D.)

Jason Sniff , LPC

Counselor - Professional

NPI 1346040862

Licensed Professional Counselor

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events
📍
Updated Practice Location August 03, 2026

Registered at 200 W MONROE ST STE 302, BLOOMINGTON, IL 617013997 (Tel: 3092046766)

📍
Updated Business Mailing Address August 03, 2026

Registered at 200 W MONROE ST STE 302, BLOOMINGTON, IL 617013997 (Tel: 3092046766)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 03, 2026

Pediatrics (License #036.176418 in IL)

📍
Updated Practice Location June 29, 2022

Registered at 1937 S BURNSIDE AVE, GONZALES, LA 707374632 (Tel: 2257655500)

📍
Updated Business Mailing Address June 29, 2022

Registered at 5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 708166038 (Tel: 2257655500)

NPI Profile Active April 11, 2019

NPI status registered as active in NPPES database

📍
Updated Practice Location April 11, 2019

Registered at 7777 HENNESSY BLVD STE 6004, BATON ROUGE, LA 708084300 (Tel: 2257653368)

📍
Updated Business Mailing Address April 11, 2019

Registered at 7777 HENNESSY BLVD STE 6004, BATON ROUGE, LA 708084300 (Tel: 2257653368)

👤
Provider Name / Credentials Updated April 11, 2019

Recorded as ELIZABETH WALLIS, MD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 11, 2019

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration April 11, 2019

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1821551334
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 11, 2019
Last Update: August 03, 2026
Sole Proprietor: No

Mailing Address

200 W Monroe St Ste 302

Bloomington, IL 617013997

Phone: 3092046766

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.