Individual provider Active NPI

Lauren Wallis

  • Family Nurse Practitioner
  • Binghamton, NY
National Provider Identifier
1679445696
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
357599 Issued in NY
Practice address
169 Riverside Dr
Binghamton, NY 13905-4246
Phone
(570) 904-1213
NPI assigned
Sep 19, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 357599 NY Primary

Addresses

Primary practice location

169 Riverside Dr
Binghamton, NY 13905-4246

Mailing address

31 Midwood Dr
Binghamton, NY 13903-1921
Phone (570) 904-1213

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20260303001615 NY Practitioner - Nurse Practitioner 1355823030 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

161 Riverside Dr
Suite 302
Binghamton, NY 13905-4197
Phone (607) 798-1842

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
357599NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of Lourdes Memorial Hospital Inc. CurrentSince Feb 2, 2026 Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Feb 2, 2026 Accepting new patients

Locations

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

161 Riverside Dr
Ste 302
Binghamton, NY 13905
Phone (607) 798-1842

Interoperability endpoints

  • Direct secure messaging: lwallis232088@direct-guthrie.org

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1758240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758240000000",
    "number": "1679445696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 MIDWOOD DR",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139031921",
            "telephone_number": "570-904-1213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 RIVERSIDE DR",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139054246",
            "telephone_number": "570-904-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "LAUREN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-19",
        "last_updated": "2025-09-19",
        "certification_date": "2025-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "357599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Binghamton, NY

Sources for this page

Verify at the official NPI Registry.