Moira Petirs Wallace, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

ME133941 Issued in FL

Practice address

3625 University Blvd S
Jacksonville, FL 32216-4207

Phone

(904) 702-6111

NPI assigned

Jun 26, 2009

Last updated

Oct 26, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, FL2 enrollments

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 2

Specialty

Emergency Medicine

Education

Albert Einstein College of Medicine of Yeshiva University, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Paragon Emergency Services LLCGroup PAC ID 8628153087, 401 clinicians

Cep America LLCGroup PAC ID 6608056171, 995 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St Vincent's Southside Hospital, Jacksonville, FL, CCN 100307
• HCA Florida Memorial Hospital Hospital, Jacksonville, FL, CCN 100179
• Ascension Sacred Heart Gulf Hospital, Port Saint Joe, FL, CCN 100313
• Ascension St Vincent's Riverside Hospital, Jacksonville, FL, CCN 100040
• Ascension St Vincent's St Johns County Hospital, St. Johns, FL, CCN 100361

Merit-based Incentive Payment System (MIPS)

Final score

87.3 of 100Reported as group

Quality

70.94

Improvement activities

40

Cost

92.94

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Cep America, LLC

  • Emergency Medicine Physician
  • Miramar Beach, FL
  • NPI 1295442614
  Medicare reassignment Care Compare group NPD
• Paragon Emergency Services LLC

  • Emergency Medicine Physician
  • Winter Haven, FL
  • NPI 1912101650
  Medicare reassignment Care Compare group NPD
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1023063542
  Medicare reassignment NPD
• Cep America LLC

  • Emergency Medicine Physician
  • Pensacola, FL
  • NPI 1295597789
  NPD
• Cep America LLC

  • Emergency Medicine Physician
  • Fort Lauderdale, FL
  • NPI 1700747946
  NPD
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Salinas, CA
  • NPI 1649226077
  NPD
• Cep America-California

  • Emergency Medicine Physician
  • Murrieta, CA
  • NPI 1588552848
  NPD

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

• Ascension Sacred Heart Gulf

  • Rural Acute Care Hospital
  • Port St Joe, FL
  • NPI 1083941678
  Care Compare affiliation
• Memorial Healthcare Group Inc

  dba HCA Florida Memorial Hospital

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1447206438
  Care Compare affiliation
• St Lukes - St Vincents Healthcare

  dba Ascension St. Vincent's Southside

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1396926747
  Care Compare affiliation
• St Vincents Health System Inc

  dba Ascension St Vincent's St. Johns County

  • General Acute Care Hospital
  • Saint Johns, FL
  • NPI 1861078651
  Care Compare affiliation
• St Vincents Medical Center Inc

  dba Ascension St. Vincent's Riverside

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1134117575
  Care Compare affiliation
• St. Vincent's Medical Center, Inc.

  dba Ascension St Vincent's Riverside

  • Clinical Medical Laboratory
  • Jacksonville, FL
  • NPI 1669556072

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1245974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1053549212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830-13 A1A NORTH",
            "address_2": "232",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "32082",
            "telephone_number": "714-342-3689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3625 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164207",
            "telephone_number": "904-702-6111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1555 Soquel Dr",
            "address_purpose": "LOCATION",
            "city": "Santa Cruz",
            "state": "CA",
            "postal_code": "950651705",
            "country_code": "US",
            "telephone_number": "831-462-7501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MOIRA",
        "middle_name": "PETIRS",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-26",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A120516",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME133941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Wallace, MSW
• Lisa Wallace
• Lisa Lynn Wallace, RN
• Marquita Wallace, PHARMD, RPH
• Michael Wallace, MD
• Nicholas James Wallace, DMD
• Patricia J Wallace, ARNP-BC
• Phillip Tyler Wallace, APRN
• Ricky Wallace
• Shanthalitta Seals Wallace, LMHC

• Emergency Medicine Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Emergency Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2023; 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.