NPIMap

Individual provider Active NPI

Brenda Wallace, PA-C

  • Physician Assistant
  • Rockwall, TX
National Provider Identifier
1104130426
Registry record updated Sep 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA06792 Issued in TX
Practice address
3142 Horizon Rd Ste 209
Rockwall, TX 75032-7802
Phone
(972) 771-2018
Fax
(972) 772-4654
NPI assigned
Jul 28, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA06792 TX Primary

Addresses

Primary practice location

3142 Horizon Rd Ste 209
Rockwall, TX 75032-7802

Mailing address

3142 Horizon Rd Ste 209
Rockwall, TX 75032-7802
Phone (972) 771-2018

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20101116000997 TX Practitioner - Physician Assistant 4981683133 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Texas Health Physicians GroupGroup PAC ID 4385535954, 1,364 clinicians

Practice addresses (Care Compare)

1600 Hospital Pkwy
Bedford, TX 76022-6913
Phone (817) 684-2708

251 Westpark Way
Suite 212
Euless, TX 76040-3707
Phone (214) 570-2319

3142 Horizon Rd
Suite 209
Rockwall, TX 75032-7802
Phone (972) 771-2018

4333 N Josey LN
Suite 104
Carrollton, TX 75010-4620
Phone (972) 394-4500

8440 Walnut Hill LN
Suite 800
Dallas, TX 75231-3825
Phone (214) 345-5999

Hospital & facility affiliations

  • Sunrise Home Health Services Home health agency, Rockwall, TX, CCN 677158
  • Texas Health Presbyterian Hospital Rockwall Hospital, Rockwall, TX, CCN 670044
  • Hunt Regional Medical Center Hospital, Greenville, TX, CCN 450352
  • Baylor Scott and White Medical Center Lake Pointe Hospital, Rowlett, TX, CCN 450742

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA06792TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group CurrentSince Apr 1, 2016 Accepting new patients
Texas Health Physicians Group CurrentSince Apr 1, 2016 Accepting new patients
Rockwall Family Medicine Associates, PA Past Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

4333 N Josey Ln
Ste 104
Carrollton, TX 75010
Phone (972) 394-4500

1200 Summer Lee Dr
Ste 102
Rockwall, TX 75032
Phone (972) 772-4644

3142 Horizon Rd
Ste 209
Rockwall, TX 75032
Phone (972) 771-2018

Interoperability endpoints

  • Direct secure messaging: bwallace718201@direct.texashealth.org

Organizations & group practices 4

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1280275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567987200000",
    "number": "1104130426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3142 HORIZON RD STE 209",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750327802",
            "telephone_number": "972-771-2018",
            "fax_number": "972-772-4654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3142 HORIZON RD STE 209",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750327802",
            "telephone_number": "972-771-2018",
            "fax_number": "972-772-4654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BRENDA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-28",
        "last_updated": "2019-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockwall, TX

Sources for this page

Verify at the official NPI Registry.