Dr Shana Dale Wallace, MD in Charlotte, NC - Medicare Psychiatry & Neurology

Dr Shana Dale Wallace, MD is a medicare enrolled "Psychiatry & Neurology - Neurology With Special Qualifications In Child Neurology" physician in Charlotte, North Carolina. Her current practice location is 1900 Randolph Rd, Suite 1010, Charlotte, North Carolina. You can reach out to her office (for appointments etc.) via phone at (704) 384-1390.

Dr Shana Dale Wallace is licensed to practice in North Carolina (license number 200401063) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1013040666.

Contact Information

	Dr Shana Dale Wallace, MD
	1900 Randolph Rd, Suite 1010, Charlotte, NC 28207-1122
	(704) 384-1390
	(704) 384-1063

Map and Direction

Physician's Profile

Full Name	Dr Shana Dale Wallace
Gender	Female
Speciality	Psychiatry & Neurology - Neurology With Special Qualifications In Child Neurology
Location	1900 Randolph Rd, Charlotte, North Carolina
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1013040666
Provider Enumeration Date: 03/13/2007
Last Update Date: 10/25/2020

Medicare PECOS Information:

PECOS PAC ID: 4880832401
Enrollment ID: I20180927000218

Medical Identifiers

Medical identifiers for Dr Shana Dale Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1013040666	NPI	-	NPPES
5907566	Medicaid	NC
200401063	Other	NC	MEDICAL LICENSE

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
2080P0008X	Pediatrics - Neurodevelopmental Disabilities	2004-01063 (North Carolina)	Secondary
2084N0402X	Psychiatry & Neurology - Neurology With Special Qualifications In Child Neurology	200401063 (North Carolina)	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. Dr Shana Dale Wallace allows following entities to bill medicare on her behalf.

Entity Name	Novant Medical Group Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1366409492 PECOS PAC ID: 1153234893 Enrollment ID: O20031121000692

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 Shana Dale 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
Dr Shana Dale Wallace, MD Po Box 60447, Charlotte, NC 28260-0447 Ph: (704) 384-1390	Dr Shana Dale Wallace, MD 1900 Randolph Rd, Suite 1010, Charlotte, NC 28207-1122 Ph: (704) 384-1390

Reviews and Comments

Psychiatry & Neurology Doctors in Charlotte, NC

Ryan Alan Williamson, M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 200 Hawthorne Ln, Charlotte, NC 28204 Phone: 704-384-9437
Soong Hyun Lee, M.D. Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: Behavioral Health Center Cmc Randolph, 501 Billingsley Road, Charlotte, NC 28211 Phone: 704-358-2700 Fax: 704-358-2716
Dr. Richard David Jacobson, MD, PHD Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 4228 Brookfield Dr, Charlotte, NC 28210 Phone: 615-345-5400
Stephanie Francis Newby, MD Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 501 Billingsley Rd, Ste B, Charlotte, NC 28211 Phone: 704-444-2400
Dr. T Hemanth Rao, M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 2607 E 7th St Ste 200, Charlotte, NC 28204 Phone: 704-449-6064 Fax: 704-731-0936
Boris Maximovich Kiselev, MD Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 501 Billingsley Rd, Ste B, Charlotte, NC 28211 Phone: 704-444-2400
Dr. Sumul Modi, M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 5500 Executive Center Dr Ste 206, Charlotte, NC 28212 Phone: 984-777-9940 Fax: 877-794-5929

Dr Shana Dale Wallace, MD - Medicare Psychiatry & Neurology in Charlotte, NC