Dane C Wallace, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.025563 Issued in IL

Practice address

529 Hillsboro Ave
Edwardsville, IL 62025-1864

Phone

(217) 621-8675

NPI assigned

Aug 22, 2022

Sex

Male

Sole proprietor

Yes

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

Enrolled in IL, MO2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cepamerica Illinois LLPGroup PAC ID 3274793633, 492 clinicians

Vituity - Illinois Auc LLPGroup PAC ID 0547516932, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HSHS St Elizabeth'S Hospital Hospital, O Fallon, IL, CCN 140187
• St Johns Hospital Hospital, Springfield, IL, CCN 140053

Merit-based Incentive Payment System (MIPS)

Final score

93.41 of 100Reported as group

Quality

86.81

Improvement activities

40

Cost

77.34

Merit-based Incentive Payment System (MIPS)

Final score

87.3 of 100Reported as group

Quality

70.94

Improvement activities

40

Cost

92.94

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dwalla02@yourcarecommunity.org

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.

• Cepamerica Illinois LLP

  • Emergency Medicine Physician
  • Elgin, IL
  • NPI 1912283110
  Medicare reassignment Care Compare group NPD
• Vituity - Illinois Auc LLP

  • Emergency Medicine Physician
  • Effingham, IL
  • NPI 1306334198
  Medicare reassignment Care Compare group NPD
• Ahs Il Medical Group LLC

  • Clinic/Center
  • Granite City, IL
  • NPI 1659098101
  Medicare reassignment NPD
• Cep America, LLC

  • Emergency Medicine Physician
  • Saint Louis, MO
  • NPI 1619332046
  Medicare reassignment NPD
• Cepamerica Illinois LLP

  • Emergency Medicine Physician
  • Effingham, IL
  • NPI 1629577812
  NPD
• Cepamerica Illinois LLP

  • Emergency Medicine Physician
  • Springfield, IL
  • NPI 1871360297
  NPD
• Vituity - Illinois Auc LLP

  • Emergency Medicine Physician
  • O Fallon, IL
  • NPI 1487142022
  NPD
• Cep America LLC

  • Emergency Medicine Physician
  • Fort Lauderdale, FL
  • NPI 1700747946
  NPD
• Cep America LLC

  • Emergency Medicine Physician
  • Richmond Heights, MO
  • NPI 1942855366
  NPD
• Cep America - California

  • Emergency Medicine Physician
  • Pomona, CA
  • NPI 1740235258
  NPD (past)

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

• St Elizabeths Hospital of the Hospital Sisters of the Third Order

  • General Acute Care Hospital
  • O Fallon, IL
  • NPI 1629057302
  Care Compare affiliation
• St Johns Hospital of the Hospital Sisters of the Third Order of St F

  • General Acute Care Hospital
  • Springfield, IL
  • NPI 1205818481
  Care Compare affiliation

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

{
    "created_epoch": "1661126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1528787744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 HILLSBORO AVE",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620251864",
            "telephone_number": "217-621-8675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 HILLSBORO AVE",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620251864",
            "telephone_number": "217-621-8675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DANE",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-22",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.025563",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2023036829",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Elizabeth Vogel, PHARMD
• Alicia Vosholler
• Nathan Andrew Vuagniaux, D.C.
• Walgreen Co
• Walgreen Co.
• Tammy Lynn Walls
• Jordan Boyer Walters
• Taletta Ann Watson, D.M.D.
• Angela Marie Watters, M.S., CCC-SLP
• Amanda R Weber, PMHNP-BC

• Family Nurse Practitioner in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 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.