Marty Dale Wallace, CRNA in Johnson City, TN - Medicare Certified Registered Nurse Anesthetist (crna)

Marty Dale Wallace, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Johnson City, Tennessee. He graduated from nursing school in 2008 and has 16 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). He is a member of the group practice Huntsville Hospital Anesthesia and his current practice location is 1114 Sunset Dr, Suite 4, Johnson City, Tennessee. You can reach out to his office (for appointments etc.) via phone at (423) 283-0776.

Marty Dale Wallace is licensed to practice in Tennessee (license number APN13700) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1164674743.

Contact Information

	Marty Dale Wallace, CRNA
	1114 Sunset Dr, Suite 4, Johnson City, TN 37604-2969
	(423) 283-0776
	(423) 283-0549

Map and Direction

Provider's Profile

Full Name	Marty Dale Wallace
Gender	Male
Speciality	Certified Registered Nurse Anesthetist (crna)
Experience	16 Years
Location	1114 Sunset Dr, Johnson City, Tennessee
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Marty Dale Wallace graduated from nursing school in 2008

NPI Data:

NPI Number: 1164674743
Provider Enumeration Date: 10/15/2008
Last Update Date: 11/20/2009

Medicare PECOS Information:

PECOS PAC ID: 5799845822
Enrollment ID: I20110610000365

Medical Identifiers

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

Identifier	Type	State	Issuer
1164674743	NPI	-	NPPES
1510077	Medicaid	TN

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
367500000X	Nurse Anesthetist, Certified Registered	APN13700 (Tennessee)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Huntsville Hospital	Huntsville, AL	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Huntsville Hospital Anesthesia	7315990751	143

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. Marty Dale Wallace allows following entities to bill medicare on his behalf.

Entity Name	Huntsville Hospital Anesthesia
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1851321079 PECOS PAC ID: 7315990751 Enrollment ID: O20050225000538

Entity Name	Physynergy Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1134465560 PECOS PAC ID: 6204081292 Enrollment ID: O20130222000456

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. Marty 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
Marty Dale Wallace, CRNA Po Box 3727, Johnson City, TN 37602-3727 Ph: (423) 283-0776	Marty Dale Wallace, CRNA 1114 Sunset Dr, Suite 4, Johnson City, TN 37604-2969 Ph: (423) 283-0776

Reviews and Comments

Nurse Anesthetist, Certified Registered Nurses in Johnson City, TN

Shawn D Bright, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 1009 Novus Dr Ste 2, Johnson City, TN 37604 Phone: 423-283-0776 Fax: 423-283-0549
Lisa W Green, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1009 Lark St, Suite 2, Johnson City, TN 37604 Phone: 423-283-0776 Fax: 423-283-0549
Marcos D Demoura, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 818 Sunset Dr Ste 103, Johnson City, TN 37604 Phone: 423-794-3142
Chasity A Huffman, RN Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1009 Novus Dr Ste 2, Johnson City, TN 37604 Phone: 423-283-0776 Fax: 423-968-5697
Mrs. Jewel B Welch, CRNAP Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1009 Novus Dr, Johnson City, TN 37604 Phone: 423-283-0776
Johnny Lee Estep, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1009 Novus Dr, Johnson City, TN 37604 Phone: 423-282-0776
Samuel V Davenport, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 400 N State Of Franklin Rd, Johnson City, TN 37604 Phone: 423-431-6111

Marty Dale Wallace, CRNA - Medicare Certified Registered Nurse Anesthetist (crna) in Johnson City, TN