Talia Nicole Wallace, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AC002032 Issued in MD

Practice address

300 Medical Pkwy Ste 314
Chesapeake, VA 23320-4985

Phone

(757) 312-6195

Fax

(757) 937-0998

NPI assigned

Aug 3, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Peak Wellness and Aesthetics, LLCGroup PAC ID 6103364153, 8 clinicians

Chesapeake Regional Medical GroupGroup PAC ID 8426113663, 148 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Chesapeake General Hospital Hospital, Chesapeake, VA, CCN 490120
• Sentara Albemarle Medical Center Hospital, Elizabeth City, NC, CCN 340109

Merit-based Incentive Payment System (MIPS)

Final score

90.57 of 100Reported as group

Quality

87.01

Promoting interoperability

100

Improvement activities

40

Cost

81.57

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: talia.wallace.1@5072.direct.athenahealth.com

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

• Chesapeake Regional Medical Group

  • Surgery Physician
  • Chesapeake, VA
  • NPI 1699940270

  Family

  Medicare reassignment Care Compare group NPD
• Peak Wellness and Aesthetics LLC

  • Obesity Medicine (Preventive Medicine) Physician
  • Chesapeake, VA
  • NPI 1023865078
  Medicare reassignment Care Compare group
• Kirven Orthopedic Group, P.C.

  • Orthopaedic Surgery of the Spine Physician
  • Virginia Beach, VA
  • NPI 1144403262
  Medicare reassignment NPD
• Center for Pain Management, LLC

  • Interventional Pain Medicine Physician
  • Hagerstown, MD
  • NPI 1962463265

  DC

  Medicare reassignment
• Chesapeake Regional Medical Group

  • Urgent Care Clinic/Center
  • Chesapeake, VA
  • NPI 1255215133
  NPD

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

• Chesapeake Hospital Authority

  • General Acute Care Hospital
  • Virginia Beach, VA
  • NPI 1003265075
  Care Compare affiliation
• Chesapeake Hospital Authority

  • Pharmacy
  • Chesapeake, VA
  • NPI 1558466318

  Hospital

  Care Compare affiliation
• Chesapeake Hospital Authority

  • General Acute Care Hospital
  • Chesapeake, VA
  • NPI 1700896354
  Care Compare affiliation
• Sentara Albemarle Regional Medical Center

  • General Acute Care Hospital
  • Elizabeth City, NC
  • NPI 1245211168
  Care Compare affiliation

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

{
    "created_epoch": "1501718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1063937753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "667 KINGSBOROUGH SQ STE 101",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233204999",
            "telephone_number": "757-842-4481",
            "fax_number": "757-312-3135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MEDICAL PKWY STE 314",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233204985",
            "telephone_number": "757-312-6195",
            "fax_number": "757-937-0998"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10215 Fernwood Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Bethesda",
            "state": "MD",
            "postal_code": "208171183",
            "country_code": "US",
            "telephone_number": "301-493-4440",
            "fax_number": "301-493-9778",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TALIA",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-03",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "AC002032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharon Walker, LPC
• Tierra Walker
• Tonya Walker, CPHT
• Zachary Walker, BCBA
• Miata Quintae Wallace, MS
• Andria Nanette Wallen
• Uranda Mae Waller, LCSW, CCTP
• William Harvey Walls Jr., D.D.S.
• Robert Seamus Walsh, PAC
• Joy Walston

• Family Nurse Practitioner in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; 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.