Derrick I Wallace, MD is a medicare enrolled "Otolaryngology" physician in Nutley, New Jersey. He went to Icahn School Of Medicine At Mount Sinai and graduated in 1996 and has 28 years of diverse experience with area of expertise as Otolaryngology. He is a member of the group practice Summit Medical Group Pa and his current practice location is
187 Washington Ave, Suite 2i, Nutley, New Jersey. You can reach out to his office (for appointments etc.) via phone at
(973) 235-0090.
Derrick I Wallace is licensed to practice in New Jersey (license number 25MA08175200) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1114900362.
Physician's Profile
| Full Name | Derrick I Wallace |
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| Gender | Male |
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| Speciality | Otolaryngology |
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| Experience | 28 Years |
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| Location | 187 Washington Ave, Nutley, New Jersey |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Derrick I Wallace attended and graduated from Icahn School Of Medicine At Mount Sinai in 1996
NPI Data:
- NPI Number: 1114900362
- Provider Enumeration Date: 11/22/2005
- Last Update Date: 11/29/2011
Medicare PECOS Information:
- PECOS PAC ID: 4082657507
- Enrollment ID: I20070720000242
Medical Identifiers
Medical identifiers for Derrick I Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1114900362 | NPI | - | NPPES |
| 02237176 | Medicaid | NY | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Y00000X | Otolaryngology | 208988 (New York) | Secondary |
| 207Y00000X | Otolaryngology | 25MA08175200 (New Jersey) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Summit Medical Group Pa | 5395642276 | 1253 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Derrick I Wallace allows following entities to bill medicare on his behalf.
| Entity Name | Summit Medical Group Pa |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1942254347
PECOS PAC ID: 5395642276
Enrollment ID: O20031218000011 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Derrick I Wallace is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Derrick I Wallace, MD
187 Washinton Ave, Suite 2i,
Nutley, NJ 07110-1980
Ph: (973) 235-0090 | Derrick I Wallace, MD
187 Washington Ave, Suite 2i,
Nutley, NJ 07110-3935
Ph: (973) 235-0090 |
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