Matthew Alexander Wallace, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

035105 Issued in NY

Practice address

489 5TH Ave FL 3
New York, NY 10017-6145

Phone

(888) 663-6331

Fax

(415) 252-7176

NPI assigned

Feb 13, 2012

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Merit-based Incentive Payment System (MIPS)

Final score

88 of 100Reported as group

Quality

74.04

Promoting interoperability

100

Improvement activities

40

Cost

70.96

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• FL-I Medical Services LLC

  • Physician Assistant
  • Haines City, FL
  • NPI 1285356790
  NPD
• FL-I Medical Services LLC

  • Emergency Medicine Physician
  • Destin, FL
  • NPI 1659720654

  Physician Assistant

  NPD
• Baxley Emergency Physicians LLC

  • Emergency Medicine Physician
  • New Port Richey, FL
  • NPI 1538118484
  NPD (past)
• Incare Health Solutions LLC

  dba Walk in Urgent Care

  • Internal Medicine Physician
  • Marion, OH
  • NPI 1235422403
  NPD (past)

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

{
    "created_epoch": "1329091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773792000000",
    "number": "1427321041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5047 SUNCATCHER DR",
            "city": "WESLEY CHAPEL",
            "state": "FL",
            "postal_code": "335453234",
            "telephone_number": "616-318-9649",
            "fax_number": "616-333-8159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 5TH AVE FL 3",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100176145",
            "telephone_number": "888-663-6331",
            "fax_number": "415-252-7176"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5047 Suncatcher Dr",
            "address_purpose": "LOCATION",
            "city": "Wesley Chapel",
            "state": "FL",
            "postal_code": "335453234",
            "country_code": "US",
            "telephone_number": "616-318-9649",
            "fax_number": "616-333-8159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MATTHEW",
        "middle_name": "ALEXANDER",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-13",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "035105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Wallace
• Loretta Wallace
• Mario James Wallace, PT, DPT
• Marisa I Wallace, DNP, FNP-BC
• Mark Edward Wallace, M.D.
• Maureen Elizabeth Wallace, PH.D.
• Megan Wallace
• Meri Diane Wallace, LCSW
• Michelle Wallace
• Nancy E Wallace, LMSW

• Physician Assistant in New York, NY
• Providers in New York, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; 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.