| Dr Dane C Wallace, NURSE PRACTITIONER | |
|
529 Hillsboro Ave, Edwardsville, IL 62025-1864 | |
| (217) 621-8675 | |
| Not Available |
| Full Name | Dr Dane C Wallace |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner |
| Experience | 4 Years |
| Location | 529 Hillsboro Ave, Edwardsville, Illinois |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528787744 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 209.025563 (Illinois) | Primary |
| 363LF0000X | Nurse Practitioner - Family | 2023036829 (Missouri) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Hshs St Elizabeth's Hospital | O fallon, IL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Vituity - Illinois Auc Llp | 0547516932 | 31 |
| Cepamerica Illinois Llp | 3274793633 | 449 |
| Cep America Llc | 6608056171 | 732 |
| Entity Name | Cepamerica Illinois Llp |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1912283110 PECOS PAC ID: 3274793633 Enrollment ID: O20120322000587 |
| Entity Name | Vituity - Illinois Auc Llp |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1306334198 PECOS PAC ID: 0547516932 Enrollment ID: O20180627000637 |
| Entity Name | Ahs Il Medical Group Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1659098101 PECOS PAC ID: 5496111676 Enrollment ID: O20230512001300 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Dane C Wallace, NURSE PRACTITIONER 529 Hillsboro Ave, Edwardsville, IL 62025-1864 Ph: (217) 621-8675 | Dr Dane C Wallace, NURSE PRACTITIONER 529 Hillsboro Ave, Edwardsville, IL 62025-1864 Ph: (217) 621-8675 |
Jason Smith, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 413 Sanner St, Edwardsville, IL 62025 Phone: 618-203-3733 | |
Ranita R Keller, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2122 Troy Rd Ste 130, Edwardsville, IL 62025 Phone: 618-800-4500 | |
Gerthy Cipus Pierre, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1706 Cloverdale Dr, Edwardsville, IL 62025 Phone: 618-482-6959 | |
Amanda Brittany Weiss, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1329 Gerber Woods Dr, Edwardsville, IL 62025 Phone: 618-616-1234 | |
Jill Marie Heitzig, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1 Hairpin Drive, Edwardsville, IL 62026 Phone: 618-650-3956 | |
Elizabeth Ballinger, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 28 Meadow Rue Dr, Edwardsville, IL 62025 Phone: 618-631-9329 | |
Jessica R Therien, APRN, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2122 Troy Rd Ste 130, Edwardsville, IL 62025 Phone: 618-800-4500 |