Individual provider Active NPI

Matthew Isiah Wallace

  • Home Health Registered Nurse
  • Washington, DC
National Provider Identifier
1265390389
Registry record updated Mar 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health Registered NurseTaxonomy code 163WH0200X
License
NA Issued in DC
Practice address
4778 S Capitol Ter SW Unit a
Washington, DC 20032-2739
Phone
(202) 422-6987
NPI assigned
Jan 15, 2026
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 20, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WH0200X NA DC Primary
Personal Care Attendant 3747P1801X

Addresses

Primary practice location

4778 S Capitol Ter SW Unit a
Washington, DC 20032-2739

Mailing address

4778 S Capitol Ter SW Unit a
Washington, DC 20032-2739
Phone (202) 422-6987

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1768435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773964800000",
    "number": "1265390389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4778 S CAPITOL TER SW UNIT A",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200322739",
            "telephone_number": "202-422-6987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4778 S CAPITOL TER SW UNIT A",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200322739",
            "telephone_number": "202-422-6987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MATTHEW",
        "middle_name": "ISIAH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-01-15",
        "last_updated": "2026-03-20",
        "certification_date": "2026-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Home Health",
            "state": "DC",
            "license": "NA",
            "primary": true
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.