Kenneth A Wallace III, MD

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

ME73625 Issued in FL

Practice address

1091 SE 59TH St
Ocala, FL 34480-6146

Phone

(850) 597-0324

NPI assigned

Apr 25, 2006

Last updated

Apr 2, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Kenneth A Wallace Professional name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Wayne State University School of Medicine, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Citrus Multi Care LLCGroup PAC ID 8729311204, 4 clinicians

Nosky PAGroup PAC ID 6204078561, 7 clinicians

Michael J Freeman MD PAGroup PAC ID 4284714189, 6 clinicians

Skin Dermatology and Cosmetic Services PAGroup PAC ID 3274769153, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Citrus Multi Care LLC

  dba Citrus Care Clinic LLC

  • Multi-Specialty Clinic/Center
  • Crystal River, FL
  • NPI 1073099461

  Dermatology

  Medicare reassignment Care Compare group NPD
• Michael J Freeman MD PA

  • Dermatology Physician
  • Ocala, FL
  • NPI 1801083589
  Medicare reassignment Care Compare group NPD
• Nosky P.a.

  dba Day Star Skin and Cancer Center

  • Dermatology Physician
  • Poinciana, FL
  • NPI 1609215912
  Medicare reassignment Care Compare group NPD
• Skin Dermatology and Cosmetic Services, P.a.

  • Specialist
  • Orange City, FL
  • NPI 1205270824
  Medicare reassignment Care Compare group
• S M S DO PA

  dba Gulf Coast Medical Center

  • Family Medicine Physician
  • Port Richey, FL
  • NPI 1346244100
  Medicare reassignment NPD
• Pellis LLC

  • Dermatopathology Physician
  • Poinciana, FL
  • NPI 1588244503
  Medicare reassignment
• Lumen Dermatology LLC

  • Dermatology Physician
  • Lady Lake, FL
  • NPI 1235938341
  NPD
• Skin Dermatology and Cosmetic Services, P.a.

  • Dermatology Physician
  • Palm Coast, FL
  • NPI 1003582123
  NPD
• Virginia Ann Schekorra PA

  • Dermatology Physician
  • Pinellas Park, FL
  • NPI 1003004862
  NPD
• Skin Cancer and Cosmetic Dermatology Center PC

  • Dermatology Physician
  • Chattanooga, TN
  • NPI 1144419458
  NPD (past)

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585785600000",
    "number": "1295791754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1091 SE 59TH ST",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344806146",
            "telephone_number": "850-597-0324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1091 SE 59TH ST",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344806146",
            "telephone_number": "850-597-0324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KENNETH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-25",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME73625",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "ME73625",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "FL",
            "license": "ME73625",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000651600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENNETH",
            "last_name": "WALLACE",
            "middle_name": "A",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Michael Dakota Walker
• Daniel Howard Walkup, DMD
• Audrey Wallace, MD
• Eva Annmae Wallace, RN
• Hannah Wallace
• Julie Walls-Sanders
• Bonnie Louise Walls, L.C.S.W.
• James Louis Walsh, D.C.
• Walter G. Fletcher, D.D.S.
• Keisha Odeen Walters-Richards, APRN

• MOHS-Micrographic Surgery Physician in Ocala, FL
• Providers in Ocala, FL by specialty
• MOHS-Micrographic Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 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.