Mervin P Wallace, MD

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

ME95779 Issued in FL

Practice address

1264 Metropolitan Blvd
Tallahassee, FL 32312-2536

Phone

(850) 383-3471

NPI assigned

Jul 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

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

Family PracticeAlso: Geriatric Medicine

Education

Other, 2002

Medicare assignment

May accept Medicare assignment

Group practices

Capital Health Plan, Inc,Group PAC ID 6406744077, 42 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mervinwallace@tpca.allscriptsdirect.net

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.

• Capital Health Plan, Inc,

  • Health Maintenance Organization
  • Tallahassee, FL
  • NPI 1770688566
  Medicare reassignment Care Compare group NPD
• Capital Regional Healthcare LLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Tallahassee, FL
  • NPI 1417127499
  NPD (past)
• Grant Center Hospital of Ocala Inc

  • Internal Medicine Physician
  • Tallahassee, FL
  • NPI 1194751701
  NPD (past)

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736294400000",
    "number": "1346269883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15349",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323175349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1264 METROPOLITAN BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323122536",
            "telephone_number": "850-383-3471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MERVIN",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME95779",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "ME95779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "276781300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00964768",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mervin.wallacemd.p1@direct.capitalhealthplan.nextgenshare.com",
            "affiliation": "N",
            "address_1": "1264 Metropolitan Blvd",
            "city": "Tallahassee",
            "state": "FL",
            "country_code": "US",
            "postal_code": "323122536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• William Tyler Walker
• Angela Wallace Chatfield, LCSW
• Alexandra Wallace
• Angela Suzanne Wallace, OTD, M.ED., OTR/L
• Jay William Wallace, PHARM. D.
• Tangela Wallace, LPTA
• Kayla Renae Waller, FNP-C
• Wesley Waller
• Marshall David Walls, ATC
• Mary J. Walsh, M.S., CCC-SLP

• Geriatric Medicine (Family Medicine) Physician in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Geriatric Medicine (Family Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.