Holly A Wallace, APNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

9679 Issued in WI

Practice address

36500 Aurora Dr
Summit, WI 53066-4899

Phone

(262) 434-1000

Fax

(262) 434-5050

NPI assigned

Oct 17, 2019

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

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

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 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Watertown Family Practice Associates, SCGroup PAC ID 4183608037, 10 clinicians

Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Commonheart Home Health Home health agency, Waukesha, WI, CCN 527151
• Aurora Medical Center - Summit Hospital, Summit, WI, CCN 520206
• Watertown Memorial Hospital Hospital, Watertown, WI, CCN 520116

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: hwallace340409@direct.myadvocateaurora.org
• FHIR API: https://api.platform.athenahealth.com/20962/brand/1/csg/1/fhir/r4

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.

• Watertown Family Practice Associates S.C.

  • Family Medicine Physician
  • Watertown, WI
  • NPI 1811064942
  Medicare reassignment Care Compare group NPD
• Aurora Medical Group, Inc.

  • Certified Registered Nurse Anesthetist
  • Milwaukee, WI
  • NPI 1427271378
  Medicare reassignment Care Compare group
• Oak Medical SC

  • Internal Medicine Physician
  • Waukesha, WI
  • NPI 1669910345
  Medicare reassignment NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Manitowoc, WI
  • NPI 1801941075
  NPD (past)

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

• Aurora Health Care Southern Lakes, Inc.

  • General Acute Care Hospital
  • Summit, WI
  • NPI 1699008029
  Care Compare affiliation
• Commonheart, Inc.

  • Home Health Agency
  • Waukesha, WI
  • NPI 1629071121
  Care Compare affiliation
• Watertown Medical Center LLC

  • General Acute Care Hospital
  • Watertown, WI
  • NPI 1992776041
  Care Compare affiliation

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

{
    "created_epoch": "1571270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1124660592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36500 AURORA DR",
            "city": "SUMMIT",
            "state": "WI",
            "postal_code": "530664899",
            "telephone_number": "262-434-1000",
            "fax_number": "262-434-5050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2428 N Grandview Blvd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Waukesha",
            "state": "WI",
            "postal_code": "531886906",
            "country_code": "US",
            "telephone_number": "262-875-5070",
            "fax_number": "866-384-9486",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "HOLLY",
        "middle_name": "A",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-17",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "9679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100094369",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hwallace340409@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "36500 Aurora Dr",
            "city": "Summit",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530664899",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "36500 Aurora Dr",
            "city": "Summit",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530664899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nicholas P Vaughn, MD
• Timothy Vellinga, MD
• Eric G Verwiebe, M.D.
• Diego Cole Villacis, M.D.
• Richard J. Wakefield, M.D.
• Timothy M Wallace, MD
• Christine Wallat, SLP
• Anthony J Wampole, M.D.
• Shelley K Watters, MD
• Dean M Weich Jr., DO

• Nurse Practitioner in Summit, WI
• Providers in Summit, WI by specialty
• Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; 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.