Annaliesa Wallace, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA09066 Issued in TX

Practice address

1331 Bandera Hwy
Ste 2
Kerrville, TX 78028-9515

Phone

(830) 895-7755

Fax

(830) 895-7757

NPI assigned

Jun 5, 2014

Last updated

Mar 10, 2020By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in TX

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

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Kerr County OB/GYN Associates, P.a.Group PAC ID 9032019146, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peterson Regional Medical Center Hospital, Kerrville, TX, CCN 450007
• Hill Country Memorial Hospital Hospital, Fredericksburg, TX, CCN 450604

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Kerr County OB/GYN Associates, P.a.

  dba OB/GYN Associates, P.A.

  • Obstetrics & Gynecology Physician
  • Kerrville, TX
  • NPI 1376505925
  Medicare reassignment Care Compare group
• Peterson Medical Associates

  • Obstetrics & Gynecology Physician
  • Kerrville, TX
  • NPI 1770800575
  NPD (past)

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

• Methodist Healthcare System of San Antonio, LTD., L.L.P.

  dba Methodist Hospital Hill Country

  • General Acute Care Hospital
  • Fredericksburg, TX
  • NPI 1376256354
  Care Compare affiliation
• Sid Peterson Memorial Hospital

  dba Peterson Regional Medical Center

  • Rural Acute Care Hospital
  • Kerrville, TX
  • NPI 1790782704
  Care Compare affiliation

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

{
    "created_epoch": "1401926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1255744363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 HILL COUNTRY DR",
            "address_2": "STE 300A",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780286079",
            "telephone_number": "830-895-7755",
            "fax_number": "830-895-7757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 BANDERA HWY",
            "address_2": "STE 2",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780289515",
            "telephone_number": "830-895-7755",
            "fax_number": "830-895-7757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ANNALIESA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-05",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA09066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "8301NJ",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randall L Wagner, DDS
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-0508)
• Wal-Mart Stores Texas, LP (Vision Center 30-0508)
• Walgreen Co (Walgreens #03730)
• Dakota Walker, PT, DPT
• Melissa G Wampler, MD
• Kami Rave Ward, DC
• Thad Ward, LCDC
• Eric-Jason McKiver Warren, CTRS
• Lisa Michelle Watts, PSY.D.

• Medical Physician Assistant in Kerrville, TX
• Providers in Kerrville, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; 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.