Ryan Jeffrey Wallace, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

1226276 Issued in PA

Practice address

5401 Peach St Ste 3300
Erie, PA 16509-2601

Phone

(814) 868-7840

NPI assigned

Jun 4, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Millcreek Community HospitalGroup PAC ID 8426020173, 67 clinicians

Keystone Rehabilitation Systems IncGroup PAC ID 7012826753, shared by 15 NPIs, 750 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lecom Medical Center and Behavioral Health Pav Hospital, Erie, PA, CCN 390198

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rwallace@maoeim-pa.direct.office.nextgen.com

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.

• Millcreek Community Hospital

  • Orthopaedic Surgery Physician
  • Erie, PA
  • NPI 1952935892
  Medicare reassignment Care Compare group NPD
• Millcreek Community Hospital

  • General Acute Care Hospital
  • Erie, PA
  • NPI 1548263973
  NPD

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

• Millcreek Community Hospital

  • Internal Medicine Physician
  • Erie, PA
  • NPI 1245126762

  Hospital

  Care Compare affiliation
• Millcreek Community Hospital

  • Cardiovascular Disease Physician
  • Erie, PA
  • NPI 1245865583

  Hospital

  Care Compare affiliation
• Millcreek Community Hospital

  • Family Medicine Physician
  • Waterford, PA
  • NPI 1326934746

  Hospital

  Care Compare affiliation
• Millcreek Community Hospital

  • Ophthalmology Physician
  • Erie, PA
  • NPI 1366338881

  Hospital

  Care Compare affiliation
• Millcreek Community Hospital

  • General Acute Care Hospital
  • Erie, PA
  • NPI 1548263973
  Care Compare affiliation
• Millcreek Community Hospital

  • Geriatric Medicine (Internal Medicine) Physician
  • Erie, PA
  • NPI 1831085356

  Hospital

  Care Compare affiliation
• Millcreek Community Hospital

  • Family Medicine Physician
  • Erie, PA
  • NPI 1851287288

  Hospital

  Care Compare affiliation
• Millcreek Community Hospital

  • Family Medicine Physician
  • Erie, PA
  • NPI 1952297467

  Hospital

  Care Compare affiliation
• Millcreek Community Hospital

  • Orthopaedic Surgery Physician
  • Erie, PA
  • NPI 1952935892

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1748995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748995200000",
    "number": "1285528422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 PEACH ST STE 3300",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 PEACH ST STE 3300",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092601",
            "telephone_number": "814-868-7840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "RYAN",
        "middle_name": "JEFFREY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-06-04",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "1226276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherilee A Walker, D.C.
• Robert Charles Walkow, PSYCHOLOGIST
• Kelli Walkowiak
• Cathy Wall, LPC
• Kristen Wallace
• Walnut Creek PA Opco LLC
• Alissa Jeanne Walsh, LPC, CAADC, ATR-BC
• Emily Walsh, OD
• Nicolette C Walsh, MD
• Gregory James Walters, M.A., NCC, LPC

• Surgical Physician Assistant in Erie, PA
• Providers in Erie, PA by specialty
• Surgical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 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.