Mrs Cynthia Wallace, AGPCNP in Medford, OR - Medicare Nurse Practitioner

Mrs Cynthia Wallace, AGPCNP is a medicare enrolled "Nurse Practitioner - Gerontology" in Medford, Oregon. She graduated from nursing school in 2014 and has 11 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Providence Health And Services Oregon and her current practice location is 1111 Crater Lake Ave, Medford, Oregon. You can reach out to her office (for appointments etc.) via phone at (541) 732-5250.

Mrs Cynthia Wallace is licensed to practice in Oregon (license number 201500016NP-PP) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1811393648.

Contact Information

	Mrs Cynthia Wallace, AGPCNP
	1111 Crater Lake Ave, Medford, OR 97504-6241
	(541) 732-5250
	(541) 732-5251

Map and Direction

Provider's Profile

Full Name	Mrs Cynthia Wallace
Gender	Female
Speciality	Nurse Practitioner
Experience	11 Years
Location	1111 Crater Lake Ave, Medford, Oregon
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Mrs Cynthia Wallace graduated from nursing school in 2014

NPI Data:

NPI Number: 1811393648
Provider Enumeration Date: 11/05/2014
Last Update Date: 09/30/2020

Medicare PECOS Information:

PECOS PAC ID: 7911219035
Enrollment ID: I20150702000790

Medical Identifiers

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

Identifier	Type	State	Issuer
1811393648	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LG0600X	Nurse Practitioner - Gerontology	201500016NP-PP (Oregon)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Providence Medford Medical Center	Medford, OR	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Providence Health And Services Oregon	6305755000	17

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. Mrs Cynthia Wallace allows following entities to bill medicare on her behalf.

Entity Name	Providence Health & Services - Oregon
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1093976243 PECOS PAC ID: 3476450560 Enrollment ID: O20031217000186

Entity Name	Providence Health & Services Oregon
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1043366172 PECOS PAC ID: 6305755000 Enrollment ID: O20040126000526

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. Mrs Cynthia 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
Mrs Cynthia Wallace, AGPCNP Po Box 3308, Portland, OR 97208-3308 Ph: (541) 732-5250	Mrs Cynthia Wallace, AGPCNP 1111 Crater Lake Ave, Medford, OR 97504-6241 Ph: (541) 732-5250

Reviews and Comments

Nurse Practitioner Nurses in Medford, OR

Carla Ann Cochran, NP-C, FNP, AGACNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 555 Black Oak Dr., Suite 300, Medford, OR 97504 Phone: 903-463-0003
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Mrs. Lauren E Hodgdon, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1698 E Mcandrews Rd Ste 200, Medford, OR 97504 Phone: 541-732-5537
Kaitlin Eileen Stapleton, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3270 Hillcrest Road, Medford, OR 97504 Phone: 541-779-1672
Elizabeth L Pethtel, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 3170 State St, Medford, OR 97504 Phone: 541-864-8900 Fax: 541-245-3315

Mrs Cynthia Wallace, AGPCNP - Medicare Nurse Practitioner in Medford, OR