Bradley S Wallace, LMFT in Bristol, TN - Medicare Marriage & Family Therapist Provider

Bradley S Wallace, LMFT is a medicare enrolled "Marriage & Family Therapist" provider in Bristol, Tennessee. His current practice location is 1145 Volunteer Pkwy, Bristol, Tennessee. You can reach out to his office (for appointments etc.) via phone at (423) 989-4500.

Bradley S Wallace is licensed to practice in Tennessee (license number 1777) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1215706528.

Contact Information

	Bradley S Wallace, LMFT
	1145 Volunteer Pkwy, Bristol, TN 37620-4652
	(423) 989-4500
	(423) 989-4582

Map and Direction

Healthcare Provider's Profile

Full Name	Bradley S Wallace
Gender	Male
Speciality	Marriage & Family Therapist
Location	1145 Volunteer Pkwy, Bristol, Tennessee
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1215706528
Provider Enumeration Date: 12/28/2023
Last Update Date: 03/04/2025

Medicare PECOS Information:

PECOS PAC ID: 5799136222
Enrollment ID: I20240109004642

Medical Identifiers

Medical identifiers for Bradley S Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1215706528	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
106H00000X	Marriage & Family Therapist	1777 (Tennessee)	Primary

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. Bradley S Wallace allows following entities to bill medicare on his behalf.

Entity Name	Frontier Health
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1720147408 PECOS PAC ID: 2860302320 Enrollment ID: O20040109000560

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. Bradley S 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
Bradley S Wallace, LMFT 1167 Spratlin Park Dr, Gray, TN 37615-6205 Ph: (423) 467-3600	Bradley S Wallace, LMFT 1145 Volunteer Pkwy, Bristol, TN 37620-4652 Ph: (423) 989-4500

Reviews and Comments

Marriage & Family Therapist in Bristol, TN

Christy R. Crick, MA, LMFT Couples Therapy Medicare: Medicare Enrolled Practice Location: 26 Midway St, Bristol, TN 37620 Phone: 423-989-4500 Fax: 423-989-4582
Candice Hutchens, LMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 739 Bluff City Hwy, Bristol, TN 37620 Phone: 423-217-1097
Mrs. Margaret L Cress, LMPT Couples Therapy Medicare: Medicare Enrolled Practice Location: 26 Midway Street, Brcc, Bristol, TN 37620 Phone: 423-989-4500 Fax: 423-989-4582
Mr. Joe Wayne Page, MA LMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 26 Midway Street, Bristol, TN 37620 Phone: 423-989-4500 Fax: 423-989-4582
Ms. Jean Murray Gay-asher, LMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 523 Holston Ave, Suite 4, Bristol, TN 37620 Phone: 423-968-4095 Fax: 423-246-9800
Ms. Susan Marie Lindsey, M.ED., L.M.F.T. Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 2405 Windsor Ave, Bristol, TN 37620 Phone: 423-967-8642

Bradley S Wallace, LMFT - Medicare Couples Therapy in Bristol, TN