Kyrsten Wallace, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

318197 Issued in NY

Practice address

750 E Adams St
Syracuse, NY 13210-2306

Phone

(315) 464-8948

NPI assigned

Mar 30, 2019

Sex

Female

Sole proprietor

Yes

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 NY

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

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Upstate Family and Preventive Medicine IncGroup PAC ID 6800185711, 30 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University Hospital S U N Y Health Science Center Hospital, Syracuse, NY, CCN 330241

Merit-based Incentive Payment System (MIPS)

Final score

92.86 of 100Reported as group

Quality

85.15

Promoting interoperability

100

Improvement activities

40

Cost

80.95

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kwallace90265@direct.upstate.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.

• Upstate Family and Preventive Medicine, Inc

  • Family Medicine Physician
  • Syracuse, NY
  • NPI 1073988911
  Medicare reassignment Care Compare group NPD
• Family Medicine Medical Service Group

  • Family Medicine Physician
  • Syracuse, NY
  • NPI 1538187075
  NPD (past)

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

• Suny Health Science Center at Syracuse

  • General Acute Care Hospital
  • Syracuse, NY
  • NPI 1578554630
  Care Compare affiliation

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

{
    "created_epoch": "1553904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670889600000",
    "number": "1407317472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 BROAD RD STE 3M",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132152265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-464-8948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KYRSTEN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-30",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "318197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kellie Faughander Wall, RD, CNSC, CDN
• Stacey B Wall, N.P.
• Alyssa Marie Wallace, LMHC
• Danielle N Wallace, RPH
• Erin Wallace
• Jason M Wallen, MD
• Kim Gabrielle Wallenstein, M.D., PH.D.
• Laura Waller, LMT
• Jodi Beth Wallis, D.O.
• Christopher Wallon

• Family Medicine Physician in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2022; 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.