Chiara Wallace, in Salt Lake City, UT - Medicare Nurse Practitioner

Chiara Wallace, is a medicare enrolled "Nurse Practitioner - Family" in Salt Lake City, Utah. Her current practice location is 961 E Crandall Ave, Salt Lake City, Utah. You can reach out to her office (for appointments etc.) via phone at (612) 770-9037.

Chiara Wallace is licensed to practice in Utah (license number 11624749-4405) 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 1073243481.

Contact Information

	Chiara Wallace,
	961 E Crandall Ave, Salt Lake City, UT 84106-2107
	(612) 770-9037
	Not Available

Map and Direction

Provider's Profile

Full Name	Chiara Wallace
Gender	Female
Speciality	Nurse Practitioner - Family
Location	961 E Crandall Ave, Salt Lake City, Utah
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1073243481
Provider Enumeration Date: 06/16/2022
Last Update Date: 11/16/2023

Medicare PECOS Information:

PECOS PAC ID: 3577915784
Enrollment ID: I20240123002926

Medical Identifiers

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

Identifier	Type	State	Issuer
1073243481	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	11624749-4405 (Utah)	Primary
390200000X	Student In An Organized Health Care Education/training Program	(* (Not Available))	Secondary

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. Chiara Wallace allows following entities to bill medicare on her behalf.

Entity Name	University Of Utah Community Physicians Group
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1598169203 PECOS PAC ID: 9739403569 Enrollment ID: O20150126002118

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. Chiara 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
Chiara Wallace, 961 E Crandall Ave, Salt Lake City, UT 84106-2107 Ph: (612) 770-9037	Chiara Wallace, 961 E Crandall Ave, Salt Lake City, UT 84106-2107 Ph: (612) 770-9037

Reviews and Comments

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Chiara Wallace, - Medicare Nurse Practitioner in Salt Lake City, UT