Dr Kevin R Wallace, DMD - Medicare Dentist in Chicago, IL

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Dr Kevin R Wallace, DMD is a medicare enrolled "Dentist - General Practice" provider in Chicago, Illinois. He graduated from medical school in 1990 and has 34 years of diverse experience with area of expertise as Oral Surgery. He is a member of the group practice Dental Sleep Center Richard A Craig Dds Ltd and his current practice location is 150 E Huron St, Ste 1103, Chicago, Illinois. You can reach out to his office (for appointments etc.) via phone at (312) 676-9893.

Dr Kevin R Wallace is licensed to practice in Illinois (license number 019022339) and he also participates in the medicare program. He may accept medicare assignments (which means he may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and his NPI Number is 1053423285.

Contact Information

Dr Kevin R Wallace, DMD
150 E Huron St, Ste 1103,
Chicago, IL 60611
(312) 676-9893
(815) 744-7059

Map and Direction




Healthcare Provider's Profile

Full NameDr Kevin R Wallace
GenderMale
SpecialityOral Surgery
Experience34 Years
Location150 E Huron St, Chicago, Illinois
Accepts Medicare AssignmentsMay be. He may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Dr Kevin R Wallace graduated from medical school in 1990
  NPI Data:
  • NPI Number: 1053423285
  • Provider Enumeration Date: 09/01/2006
  • Last Update Date: 01/19/2021
  Medicare PECOS Information:
  • PECOS PAC ID: 1951691237
  • Enrollment ID: I20160620000860

Medical Identifiers

Medical identifiers for Dr Kevin R Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1053423285NPI-NPPES
1053431981OtherILGROUP TYPE II NPI
1306177241OtherILPRACTICE LOCATION TYPE II NPI
1205145554OtherILPRACTICE LOCATION TYPE II NPI
1508198474OtherILPRACTICE LOCATION TYPE II NPI
1760882005OtherILPRACTICE LOCATION TYPE II NPI
1295165439OtherILPRACTICE LOCATION TYPE II NPI
019-022339OtherILDENTAL-IL
1063649770OtherILGROUP TYPE II NPI

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
122300000XDentist 019022339 (Illinois)Secondary
122300000XDentist 019-022339 (Illinois)Secondary
1223G0001XDentist - General Practice 019022339 (Illinois)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Northwestern Memorial HospitalChicago, ILHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Dental Sleep Center Richard A Craig Dds Ltd88202871214

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. Dr Kevin R Wallace allows following entities to bill medicare on his behalf.
Entity NameDental Sleep Center Richard A Craig Dds Ltd
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1053431981
PECOS PAC ID: 8820287121
Enrollment ID: O20110301000138

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. Dr Kevin R 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 AddressPractice Location Address
Dr Kevin R Wallace, DMD
14831 W 159th St Ste 1,
Lockport, IL 60491-9008

Ph: (630) 324-5369		Dr Kevin R Wallace, DMD
150 E Huron St, Ste 1103,
Chicago, IL 60611

Ph: (312) 676-9893

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.