Kevin H Wallace, MD

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

ME81186 Issued in FL

Practice address

1350 Hickory St
Melbourne, FL 32901-3224

Phone

(321) 434-4225

Fax

(321) 434-4247

NPI assigned

Dec 16, 2005

Last updated

Aug 26, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Critical Care (Intensivists)Also: Internal Medicine, Pulmonary Disease

Education

Howard University College of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Health First Medical Group, LLCGroup PAC ID 7416100672, 701 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Holmes Regional Medical Center Hospital, Melbourne, FL, CCN 100019
• Viera Hospital Hospital, Melbourne, FL, CCN 100315
• Parrish Medical Center Hospital, Titusville, FL, CCN 100028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kwallace23011@epicdirect.hf.org

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.

• Health First Medical Group, LLC

  • General Practice Physician
  • Melbourne, FL
  • NPI 1750626495

  Critical Care Medicine

  Medicare reassignment Care Compare group NPD
• Health First Medical Group, LLC

  • General Practice Physician
  • Rockledge, FL
  • NPI 1073268934
  NPD
• Atlanta Pulmonary Group, LLC

  • Pulmonary Disease Physician
  • Atlanta, GA
  • NPI 1326128562
  NPD (past)
• Critical Care Atlanta, LLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Atlanta, GA
  • NPI 1407012586
  NPD (past)

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

• Holmes Regional Medical Center, Inc.

  dba First Flight

  • Air Ambulance
  • Melbourne, FL
  • NPI 1235312281

  Hospital

  Care Compare affiliation
• Holmes Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Melbourne, FL
  • NPI 1295702728
  Care Compare affiliation
• North Brevard County Hospital District

  dba Parrish Medical Center

  • General Acute Care Hospital
  • Titusville, FL
  • NPI 1053424648
  Care Compare affiliation
• Viera Hospital Inc

  • General Acute Care Hospital
  • Melbourne, FL
  • NPI 1730494816
  Care Compare affiliation

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1033195631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 S FISKE BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 HICKORY ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013224",
            "telephone_number": "321-434-4225",
            "fax_number": "321-434-4247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KEVIN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-16",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "FL",
            "license": "ME81186",
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "FL",
            "license": "ME81186",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "FL",
            "license": "ME81186",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "FL",
            "license": "ME81186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014488700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Diane Walk, RPH
• Kimberly Walker
• Natacha Walker
• Sherry Walker
• Amanda Wallace
• Kristin K Wallace, LMHC
• Denise Walleck
• Chrystal A Walls, MSN, FNP
• Robert E. Walsh, PA-C
• Ira M Walter, MSN-ED, APRN, FNP

• Pulmonary Disease Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Pulmonary Disease Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.