Mrs Nichole Wallace, PA - Medicare Physician Assistant in Brooklyn, NY

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Mrs Nichole Wallace, PA is a medicare enrolled "Physician Assistant - Medical" in Brooklyn, New York. She graduated from nursing school in 2023 and has 3 years of diverse experience with area of expertise as Physician Assistant. She is a member of the group practice Carespot Of Orlando Hsi Urgent Care Llc and her current practice location is 760 Broadway, Brooklyn, New York. You can reach out to her office (for appointments etc.) via phone at (718) 312-2312.

Mrs Nichole Wallace is licensed to practice in NU (license number ) 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 1114379708.

Contact Information

Mrs Nichole Wallace, PA
760 Broadway,
Brooklyn, NY 11206-5317
(718) 312-2312
Not Available

Map and Direction




Provider's Profile

Full NameMrs Nichole Wallace
GenderFemale
SpecialityPhysician Assistant
Experience3 Years
Location760 Broadway, Brooklyn, New York
Accepts Medicare AssignmentsYes. 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 Nichole Wallace graduated from nursing school in 2023
  NPI Data:
  • NPI Number: 1114379708
  • Provider Enumeration Date: 07/06/2016
  • Last Update Date: 08/18/2023
  Medicare PECOS Information:
  • PECOS PAC ID: 0941598932
  • Enrollment ID: I20240415001291

Medical Identifiers

Medical identifiers for Mrs Nichole Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1114379708NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363AM0700XPhysician Assistant - Medical (NU)Primary

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Carespot Of Orlando Hsi Urgent Care Llc892137255855

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 Nichole Wallace allows following entities to bill medicare on her behalf.
Entity NameSolantic/south Florida LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1851344378
PECOS PAC ID: 5496762171
Enrollment ID: O20060321000740
Entity NameSolantic of Jacksonville LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1407893100
PECOS PAC ID: 1052409307
Enrollment ID: O20071120000271
Entity NameHma-solantic Joint Venture LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1689812109
PECOS PAC ID: 6002955788
Enrollment ID: O20091209000716
Entity NameShands-solantic Joint Venture LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1558595223
PECOS PAC ID: 4183764178
Enrollment ID: O20091223000343
Entity NameWest Boynton Urgent Care LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1003172628
PECOS PAC ID: 0941456537
Enrollment ID: O20120815000049
Entity NameCarespot of Orlando Hsi Urgent Care LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1306367503
PECOS PAC ID: 8921372558
Enrollment ID: O20170921000186

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 Nichole 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
Mrs Nichole Wallace, PA
833 Penfield St,
Bronx, NY 10470-1322

Ph: (718) 708-1913		Mrs Nichole Wallace, PA
760 Broadway,
Brooklyn, NY 11206-5317

Ph: (718) 312-2312

Reviews and Comments


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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.