Kelly A Wallace, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

121517 Issued in MO

Practice address

615 S New Ballas Rd
Sjmmc Dept of Anes
Saint Louis, MO 63141-8221

Phone

(636) 386-9224

Fax

(636) 386-7679

NPI assigned

Aug 18, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gateway Gastroenterology IncGroup PAC ID 2668448713, 25 clinicians

Comprehensive Anesthesia Care PCGroup PAC ID 5799698551, 43 clinicians

Western Anesthesiology Associates IncGroup PAC ID 6204720667, 251 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Lukes Hospital Hospital, Chesterfield, MO, CCN 260179

Merit-based Incentive Payment System (MIPS)

Final score

63.97 of 100Reported as group

Quality

79.89

Promoting interoperability

0

Improvement activities

40

Cost

83.34

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BBJFAD

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.

• Comprehensive Anesthesia Care PC

  • Anesthesiology Physician
  • Chesterfield, MO
  • NPI 1215975156

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Gateway Gastroenterology Inc

  • Specialist
  • Chesterfield, MO
  • NPI 1043250400
  Medicare reassignment Care Compare group NPD
• Western Anesthesiology Associates, Inc.

  • Anesthesiology Physician
  • Saint Louis, MO
  • NPI 1275646754
  Medicare reassignment Care Compare group NPD
• Orthomed Staffing LLC

  • Anesthesiology Physician
  • Addison, TX
  • NPI 1225514276

  MO

  Medicare reassignment NPD

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

• St. Lukes Episcopal-Presbyterian Hospital

  • General Acute Care Hospital
  • Chesterfield, MO
  • NPI 1346251543
  Care Compare affiliation

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782864000000",
    "number": "1669464350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 CONSORT DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630114439",
            "telephone_number": "636-386-9224",
            "fax_number": "636-386-7679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S NEW BALLAS RD",
            "address_2": "SJMMC DEPT OF ANES",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418221",
            "telephone_number": "636-386-9224",
            "fax_number": "636-386-7679"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17298 N Outer 40 Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Chesterfield",
            "state": "MO",
            "postal_code": "630051456",
            "country_code": "US",
            "telephone_number": "314-529-4900",
            "fax_number": "314-434-2679",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KELLY",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-18",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "121517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "916940117",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Wallace, MA, THM, STM
• Jorge Wallace, PLPC
• Joslyn Wallace
• Kaila Wallace, DOULA
• Keith Alan Wallace, BS PHARM
• Keri Renhui Wallace, MD
• Laura Ann Wallace, MD
• Lawanda Wallace
• Lisa Wallace, DO
• Maxwell Wallace, M.D.

• Certified Registered Nurse Anesthetist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Certified Registered Nurse Anesthetist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.