Micah R Wallace, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

MA054581 Issued in PA

Practice address

100 Excela Health Dr Ste 102
Latrobe, PA 15650-9001

Phone

(724) 804-1760

Fax

(724) 804-1762

NPI assigned

Sep 20, 2011

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

Other identifiers 1

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

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Excela Health Physician Practices, IncGroup PAC ID 6204737117, 474 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: micahwallace@emg.allscriptsdirect.net

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.

• Excela Health Physician Practices, Inc

  • Cardiovascular Disease Physician
  • Greensburg, PA
  • NPI 1821225202
  Medicare reassignment Care Compare group
• Excela Health Physician Practices, Inc

  • Family Medicine Physician
  • Jeannette, PA
  • NPI 1821705245
  NPD
• Excela Health Physician Practices, Inc.

  • Family Medicine Physician
  • Greensburg, PA
  • NPI 1235004193
  NPD
• Excela Health Physician Practices, Inc

  • Psychiatry Physician
  • Greensburg, PA
  • NPI 1861438095
  NPD (past)
• Pathways Human Services of Pennsylvania, LLC

  • Public Health or Welfare Agency
  • Greensburg, PA
  • NPI 1043822208
  NPD (past)

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

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545350400000",
    "number": "1588946214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 JEFFERSON AVE",
            "address_2": "SUITE 400",
            "city": "JEANNETTE",
            "state": "PA",
            "postal_code": "156442538",
            "telephone_number": "724-527-8060",
            "fax_number": "724-522-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 EXCELA HEALTH DR STE 102",
            "city": "LATROBE",
            "state": "PA",
            "postal_code": "156509001",
            "telephone_number": "724-804-1760",
            "fax_number": "724-804-1762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MICAH",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-20",
        "last_updated": "2018-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA054581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103167119",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maria Vonmickwitz, PHD
• Randolph Wadsworth Jr.
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Zachary Walton, DO
• Barbara K Wang, M.D.
• Thomas D Ward, M.D.
• Samantha Wargo
• Kurt Washnock, DMD

• Surgical Physician Assistant in Latrobe, PA
• Providers in Latrobe, PA by specialty
• Surgical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; 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.