NPIMap

Individual provider Active NPI

Lisa Wallace, CNP

  • Acute Care Nurse Practitioner
  • Greenville, SC
National Provider Identifier
1013349000
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
28748 Issued in SC
Practice address
200 Patewood Dr Ste B300
Greenville, SC 29615-6338
Phone
(864) 454-4200
Fax
(864) 454-4205
NPI assigned
Aug 1, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X NP-14866 OH
Acute Care Nurse Practitioner 363LA2100X 28748 SC Primary

Addresses

Primary practice location

200 Patewood Dr Ste B300
Greenville, SC 29615-6338

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other practice location 1

18101 Lorain Ave
Cleveland, OH 44111-5612
Phone (216) 476-7000

Other names 1

  • Lisa Marie Wallace Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240919003189 SC Practitioner - Nurse Practitioner 2466695648 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

200 Patewood Dr
Suite B300
Greenville, SC 29615-6338
Phone (864) 454-4200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP-14866OHMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Sep 16, 2024 Accepting new patients
Prisma Health University Medical Group CurrentSince Sep 16, 2024 Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

112 John St
Ste 201
Easley, SC 29640
Phone (864) 850-2663

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

890 W Faris Rd
Ste 570
Greenville, SC 29605
Phone (803) 232-0883

200 Patewood Dr
Ste B300
Greenville, SC 29615
Phone (864) 454-4200

890 W Faris Rd
Ste 580
Greenville, SC 29605
Phone (864) 455-7874

315 Medical Pkwy
Ste 240
Greer, SC 29650
Phone (864) 454-4200

125 Professional Park Dr
Seneca, SC 29678
Phone (864) 482-3000

727 SE Main St
Ste 120
Simpsonville, SC 29681
Phone (864) 454-6500

Interoperability endpoints

  • Direct secure messaging: lwallace812178@direct.ghs.myhfn.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 58

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 58

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1375315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1013349000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR STE B300",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296156338",
            "telephone_number": "864-454-4200",
            "fax_number": "864-454-4205"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18101 Lorain Ave",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441115612",
            "country_code": "US",
            "telephone_number": "216-476-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LISA",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-01",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OH",
            "license": "NP-14866",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "SC",
            "license": "28748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "WALLACE",
            "middle_name": "MARIE",
            "credential": "ACNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.