Maggie Mae Wallace

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-182953 Issued in AL

Practice address

200 Office Park Dr
Gulf Shores, AL 36542-3432

Phone

(251) 968-7379

Fax

(251) 968-5960

NPI assigned

Aug 13, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jun 12, 2024 through Jun 12, 2028

Merit-based Incentive Payment System (MIPS)

Final score

87.97 of 100Reported as apm

Quality

75.95

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mwallace32166@direct.med.uchc.edu

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.

• Island Life Personalized Medicine

  • Family Nurse Practitioner
  • Gulf Shores, AL
  • NPI 1730900648
  NPD Authorized official
• Yakima Neighborhood Health Services

  • Federally Qualified Health Center (FQHC)
  • Yakima, WA
  • NPI 1225085624
  NPD (past)

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

{
    "created_epoch": "1565654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1366098642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 OFFICE PARK DR",
            "city": "GULF SHORES",
            "state": "AL",
            "postal_code": "365423432",
            "telephone_number": "512-968-7379",
            "fax_number": "251-968-5960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 OFFICE PARK DR",
            "city": "GULF SHORES",
            "state": "AL",
            "postal_code": "365423432",
            "telephone_number": "251-968-7379",
            "fax_number": "251-968-5960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MAGGIE",
        "middle_name": "MAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-13",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "8373",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-182953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "maggie.wallace.1@1599.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "200 Office Park Dr",
            "city": "Gulf Shores",
            "state": "AL",
            "country_code": "US",
            "postal_code": "365423432",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tracey B Tucker, RPH
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Walgreen Co
• John Wanschek IV, PHARM.D
• Nicole Elizabeth Ward, D.C.
• Fleming K Watts, R.PH
• Wayne T. Martin, DDS, PC
• Phelan G. Webb, NBC-HIS

• Family Nurse Practitioner in Gulf Shores, AL
• Providers in Gulf Shores, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; 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; Opt Out Affidavits.
• 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.