Mrs Phyllis A Wallace, APRN is a medicare enrolled "Nurse Practitioner - Family" in Konawa, Oklahoma. She went to University Of Nebraska College Of Medicine and graduated in 2002 and has 24 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Central Oklahoma Family Medical Center Inc and her current practice location is
527 W 3rd St, Konawa, Oklahoma. You can reach out to her office (for appointments etc.) via phone at
(580) 925-3286.
Mrs Phyllis A Wallace is licensed to practice in Oklahoma (license number 35497) 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 1366486417.
Provider's Profile
| Full Name | Mrs Phyllis A Wallace |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 24 Years |
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| Location | 527 W 3rd St, Konawa, Oklahoma |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Mrs Phyllis A Wallace attended and graduated from University Of Nebraska College Of Medicine in 2002
NPI Data:
- NPI Number: 1366486417
- Provider Enumeration Date: 06/16/2006
- Last Update Date: 11/22/2021
Medicare PECOS Information:
- PECOS PAC ID: 2668511502
- Enrollment ID: I20091205000121
Medical Identifiers
Medical identifiers for Mrs Phyllis A Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1366486417 | NPI | - | NPPES |
| 100155800A | Medicaid | OK | |
| 100155800B | Other | OK | SOONERCARE PROVIDER |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363LW0102X | Nurse Practitioner - Women's Health | R0035497 (Oklahoma) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 35497 (Oklahoma) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Central Oklahoma Family Medical Center Inc | 9931189685 | 55 |
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 Phyllis A Wallace allows following entities to bill medicare on her behalf.
| Entity Name | Central Oklahoma Family Medical Center Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1831291293
PECOS PAC ID: 9931189685
Enrollment ID: O20040722001013 |
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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 Phyllis A 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 Phyllis A Wallace, APRN
527 W 3rd St,
Konawa, OK 74849-1415
Ph: (580) 925-3286 | Mrs Phyllis A Wallace, APRN
527 W 3rd St,
Konawa, OK 74849-1415
Ph: (580) 925-3286 |
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