Sara Elizabeth Wallace-Keeshen, FNP-BC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

SP027631 Issued in PA

Practice address

2144 Cecil B Moore Ave
Philadelphia, PA 19121-4014

Phone

(215) 320-6187

NPI assigned

Jun 8, 2023

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 PA

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.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: sara.wallacekeeshen.p1@direct.projecthome.nextgenshare.com

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.

• Project Home

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1609122506
  Medicare reassignment

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

{
    "created_epoch": "1686182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1407540602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 AGATE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191252302",
            "telephone_number": "864-275-4820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2144 CECIL B MOORE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191214014",
            "telephone_number": "215-320-6187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE-KEESHEN",
        "first_name": "SARA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-08",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "PA",
            "license": "SP027631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Joseph Wall, MD
• Jessica Jeanne Wall, MD
• Joy Wall
• Maryann Wall
• Matthew Lucas Wall
• Andre Lamar Wallace
• Arlene Denise Wallace, EDD
• Christopher Wallace, PT, DPT
• Christopher George Wallace, OTR/L
• Dana Marie Wallace, CRNP FNP-C

• Primary Care Nurse Practitioner in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Primary Care Nurse Practitioner in Pennsylvania

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