Lydia Wallace, - Medicare Emergency Medicine in Brockton, MA

  1. Home
  2. Emergency Medicine
  3. MA
  4. Brockton
Lydia Wallace, is a medicare enrolled "Emergency Medicine" physician in Brockton, Massachusetts. Her current practice location is 235 N Pearl St, Brockton, Massachusetts. You can reach out to her office (for appointments etc.) via phone at (617) 414-5405.

Lydia Wallace is licensed to practice in Massachusetts (license number 1024211) 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 1417344581.

Contact Information

Lydia Wallace,
235 N Pearl St,
Brockton, MA 02301-1794
(617) 414-5405
Not Available

Map and Direction




Physician's Profile

Full NameLydia Wallace
GenderFemale
SpecialityEmergency Medicine
Location235 N Pearl St, Brockton, Massachusetts
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1417344581
  • Provider Enumeration Date: 04/16/2015
  • Last Update Date: 08/02/2025
  Medicare PECOS Information:
  • PECOS PAC ID: 4688989742
  • Enrollment ID: I20191022000938

Medical Identifiers

Medical identifiers for Lydia Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1417344581NPI-NPPES
MD2019-08OtherNMLICENSE

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207P00000XEmergency Medicine MD2019-0840 (New Mexico)Secondary
207P00000XEmergency Medicine 1024211 (Massachusetts)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. Lydia Wallace allows following entities to bill medicare on her behalf.
Entity NameEmergency Staffing Solutions Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1477590974
PECOS PAC ID: 9830001650
Enrollment ID: O20070724000197
Entity NameSouthwest Emergency Medical Associates Of Nm Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1720505571
PECOS PAC ID: 8426324294
Enrollment ID: O20171023001270
Entity NameLas Cruces Hb Medical Services Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1598446171
PECOS PAC ID: 8123473600
Enrollment ID: O20231018003832

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. Lydia 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
Lydia Wallace,
960 Massachusetts Ave Ste 2,
Boston, MA 02118-2690

Ph: (617) 414-5405		Lydia Wallace,
235 N Pearl St,
Brockton, MA 02301-1794

Ph: (617) 414-5405

Reviews and Comments


Emergency Medicine Doctors in Brockton, MA

Samantha A Siegel,
Emergency Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 235 N Pearl St, Brockton, MA 02301
Phone: 508-427-3000    
Luis E. Ortiz, M.D.
Emergency Medicine
Medicare: Medicare Enrolled
Practice Location: 680 Centre St, Brockton, MA 02302
Phone: 508-941-7000    
Dr. Stephen J Simon, DO
Emergency Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 680 Centre St, Brockton, MA 02302
Phone: 508-941-7000    
Dr. John Kyle Volpe, MD
Emergency Medicine
Medicare: Medicare Enrolled
Practice Location: 680 Centre St, Brockton, MA 02302
Phone: 508-941-7200    
Grant Wei, M.D.
Emergency Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 680 Centre St, Dept. Of Emergency Medicine, Brockton, MA 02302
Phone: 508-941-7400    
Jacob F. Kallenberg,
Emergency Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 235 N Pearl St, Brockton, MA 02301
Phone: 508-427-3075    
Daniel Werzanski, MD
Emergency Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 680 Centre St, Brockton, MA 02302
Phone: 508-941-7000    

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.