Tasha B Wallace, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS8622 Issued in FL

Practice address

14651 Palm Beach Blvd Ste 100
Fort Myers, FL 33905-2331

Phone

(239) 369-2903

Fax

(239) 369-0500

NPI assigned

Nov 2, 2005

Sex

Female

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 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 Practice

Education

Rowan University School of Osteopathic Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Physiotherapy Associates IncGroup PAC ID 3577470442, shared by 50 NPIs, 1,432 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trilogy Home Healthcare Home health agency, Estero, FL, CCN 108173
• Patients First Home Care LLC Home health agency, Sarasota, FL, CCN 687176
• Cape Coral Hospital Hospital, Cape Coral, FL, CCN 100244
• Lee Memorial Hospital Hospital, Fort Myers, FL, CCN 100012

Merit-based Incentive Payment System (MIPS)

Final score

92.18 of 100Reported as individual

Quality

84.36

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tasha.wallace.1@3366.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/3366/brand/1/csg/1/fhir/r4

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.

• Wallace Family Practice PA

  • Clinic/Center
  • Lehigh Acres, FL
  • NPI 1063548410
  Medicare reassignment NPD Authorized official

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

• Bridges Home Health Inc.

  • Home Health Agency
  • Fort Myers, FL
  • NPI 1376517862
  Care Compare affiliation
• Lee Health System Inc

  • General Acute Care Hospital
  • Fort Myers, FL
  • NPI 1427806025
  Care Compare affiliation
• Lee Health System Inc

  • General Acute Care Hospital
  • Cape Coral, FL
  • NPI 1780429076
  Care Compare affiliation
• Patients First Home Care, LLC

  • Home Health Agency
  • Sarasota, FL
  • NPI 1245845312
  Care Compare affiliation

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1396736997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14651 PALM BEACH BLVD STE 100",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339052331",
            "telephone_number": "239-369-2903",
            "fax_number": "239-369-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14651 PALM BEACH BLVD STE 100",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339052331",
            "telephone_number": "239-369-2903",
            "fax_number": "239-369-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TASHA",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS8622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melinda Walker, BCABA
• Reilly Walker
• Wall Anesthesia Inc.
• Kathleen Wall, CRNA
• Jordan Wallace, PHARMD
• Anthony Waller
• Wallis Chiropractic LLC
• Deborahlee Wallis
• Kelly Wallis, D.C.
• Jaekilla Walls

• Family Medicine Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; 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.