Lisa M. Wallace, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

21595 Issued in SC

Practice address

800 E Cheves St Ste 200
Florence, SC 29506-2651

Phone

(843) 662-1502

Fax

(843) 678-3611

NPI assigned

Jan 25, 2018

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC

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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

McLeod Physician Associates IIGroup PAC ID 8224031307, 541 clinicians

McLeod Regional Medical Center of the Pee Dee IncGroup PAC ID 7416851852, 401 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• McLeod Home Health Inc Home health agency, Florence, SC, CCN 427057
• Centerwell Home Health-Pee Dee Home health agency, Florence, SC, CCN 427854
• Amedisys Home Health Care Home health agency, Kingstree, SC, CCN 427068
• McLeod Regional Medical Center-Pee Dee Hospital, Florence, SC, CCN 420051
• Musc Health Florence Medical Center Hospital, Florence, SC, CCN 420091

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lwallace19195@directmcleodehealth.org

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.

• McLeod Physician Associates II

  • Family Medicine Physician
  • Florence, SC
  • NPI 1801990494
  Medicare reassignment Care Compare group NPD
• McLeod Regional Medical Center of the Pee Dee, Inc

  • Emergency Medical Services (Emergency Medicine) Physician
  • Florence, SC
  • NPI 1154371433
  Medicare reassignment Care Compare group NPD
• Curana Health of South Carolina PC

  • Internal Medicine Physician
  • North Charleston, SC
  • NPI 1316477896
  Medicare reassignment NPD
• McLeod Health Clarendon

  • Certified Registered Nurse Anesthetist
  • Manning, SC
  • NPI 1508218793
  Medicare reassignment NPD
• McLeod Health Clarendon

  • Rural Health Clinic/Center
  • Timmonsville, SC
  • NPI 1003461773
  NPD
• McLeod Health Clarendon

  • Obstetrics & Gynecology Physician
  • Manning, SC
  • NPI 1497103618
  NPD
• McLeod Physician Associates II

  • Orthopaedic Surgery Physician
  • Florence, SC
  • NPI 1922555739
  NPD
• McLeod Regional Medical Center of the Pee Dee, Inc

  • Community/Retail Pharmacy
  • Florence, SC
  • NPI 1871775841
  NPD

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

• Capital Care Resources of South Carolina, LLC

  • Home Health Agency
  • Florence, SC
  • NPI 1528433521
  Care Compare affiliation
• Georgetown Hospital Home Health LLC

  • Home Health Agency
  • Kingstree, SC
  • NPI 1255399747
  Care Compare affiliation
• McLeod Regional Medical Center of the Pee Dee, Inc

  • Home Health Agency
  • Florence, SC
  • NPI 1215991682
  Care Compare affiliation
• McLeod Regional Medical Center of the Pee Dee, Inc.

  • General Acute Care Hospital
  • Florence, SC
  • NPI 1699756221
  Care Compare affiliation
• Medical University Hospital Authority

  • General Acute Care Hospital
  • Florence, SC
  • NPI 1184197683
  Care Compare affiliation

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

{
    "created_epoch": "1516838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614124800000",
    "number": "1235637182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3239",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295023239",
            "telephone_number": "843-777-7098",
            "fax_number": "843-777-7102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E CHEVES ST STE 200",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295062651",
            "telephone_number": "843-662-1502",
            "fax_number": "843-678-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LISA",
        "middle_name": "M.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-25",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "21595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lisa.wallace@mpaii.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "ECW DA",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EHR",
            "address_1": "800 E Cheves St Ste 200",
            "city": "Florence",
            "state": "SC",
            "country_code": "US",
            "postal_code": "295062651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Wall Drugs of Florence, Inc.
• Brantley Wallace, PHARMD
• Christy Bankston Wallace, O.D.
• Jasmika Wallace
• Kelsey Wallace
• Mandy L Wallace, MSRPT
• Robert Brian Wallace, O.D.
• Sara Davis Wallace, FNP-BC
• Jazzmine Walley
• Sharon A Walters, FNP

• Family Nurse Practitioner in Florence, SC
• Providers in Florence, SC by specialty
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2021; 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.