Individual provider Active NPI

Brittany Asta Wallace, FNP

  • Family Nurse Practitioner
  • Pittsfield, MA
National Provider Identifier
1215363239
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN2258013 Issued in MA
Practice address
510 North Street
Pittsfield, MA 01201
Phone
(413) 447-2351
Fax
(413) 445-7009
NPI assigned
Sep 23, 2013
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN2258013 MA Primary

Addresses

Primary practice location

510 North Street
Pittsfield, MA 01201

Mailing address

P.O. Box 30
Great Barrington, MA 01230
Phone (413) 528-9311

Other identifiers 1

IdentifierTypeStateIssuer
110120598AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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

Enrollment IDStateProvider typePAC IDDetails
I20140206000085 MA Practitioner - Nurse Practitioner 5092944405 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Health Programs IncGroup PAC ID 5799746608, 45 clinicians

Practice addresses (Care Compare)

510 N St
Pittsfield, MA 01201-5493
Phone (413) 447-2351

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Programs, Inc. CurrentSince Jun 1, 2017 Accepting new patients
Community Health Programs, Inc. CurrentSince Jun 1, 2017 Accepting new patients
Community Health Programs Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: brittany.wallace.1@3792.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1379894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1215363239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 30",
            "city": "GREAT BARRINGTON",
            "state": "MA",
            "postal_code": "01230",
            "telephone_number": "413-528-9311",
            "fax_number": "413-644-0274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 NORTH STREET",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "01201",
            "telephone_number": "413-447-2351",
            "fax_number": "413-445-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BRITTANY",
        "middle_name": "ASTA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-23",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN2258013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110120598A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsfield, MA

Sources for this page

Verify at the official NPI Registry.