Nichole Wallace, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

760 Broadway
Brooklyn, NY 11206-5317

Phone

(718) 312-2312

NPI assigned

Jul 6, 2016

Sex

Female

Sole proprietor

No

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 NY, FL2 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

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carespot of Orlando Hsi Urgent Care LLCGroup PAC ID 8921372558, 55 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Carespot of Orlando Hsi Urgent Care LLC

  • Urgent Care Clinic/Center
  • Orlando, FL
  • NPI 1306367503
  Medicare reassignment Care Compare group
• Balm of Gilead Medical Office, PC

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1720104474
  Medicare reassignment
• Hma/Solantic Joint Venture, LLC

  • Urgent Care Clinic/Center
  • Vero Beach, FL
  • NPI 1689812109
  Medicare reassignment
• Shands/Solantic Joint Venture, LLC

  • Urgent Care Clinic/Center
  • Gainesville, FL
  • NPI 1558595223
  Medicare reassignment
• Solantic of Jacksonville, LLC

  • Urgent Care Clinic/Center
  • Ponte Vedra, FL
  • NPI 1407893100
  Medicare reassignment
• Solantic/South Florida, LLC

  • Urgent Care Clinic/Center
  • Coral Springs, FL
  • NPI 1851344378
  Medicare reassignment
• West Boynton Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Boynton Beach, FL
  • NPI 1003172628
  Medicare reassignment

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

{
    "created_epoch": "1467763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692316800000",
    "number": "1114379708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 PENFIELD ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104701322",
            "telephone_number": "718-708-1913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 BROADWAY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112065317",
            "telephone_number": "718-312-2312"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10959 W Colonial Dr",
            "address_2": "Units 6&8",
            "address_purpose": "LOCATION",
            "city": "Ocoee",
            "state": "FL",
            "postal_code": "34761",
            "country_code": "US",
            "telephone_number": "407-554-4591",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "NICHOLE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-06",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Giselle Fourier Wallace, DDS
• Gloria Elizabeeth Wallace Jr., RN
• James Richard Wallace, M.D.
• Margaret Wallace
• Marisa Wallace, M.S. CCC-SLP
• Pamela Wallace, LCSW
• Pauline Wallace
• Reginald Wallace, M.A.
• Sandra Marie Wallace, RN
• Soraya A Wallace

• Medical Physician Assistant in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.