Ryan Wallace, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

310895 Issued in NY

Practice address

45 Reade PL
Poughkeepsie, NY 12601-3947

Phone

(917) 504-6635

NPI assigned

Jan 23, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nuvance Health Medical Practice PCGroup PAC ID 1658468442, 578 clinicians

My Medical PCGroup PAC ID 0143610600, 93 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellbound II, LLC Home health agency, Brooklyn, NY, CCN 337211
• Vassar Brothers Medical Center Hospital, Poughkeepsie, NY, CCN 330023

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678

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.

• My Medical PC

  • Family Medicine Physician
  • Valley Cottage, NY
  • NPI 1518637891
  Medicare reassignment Care Compare group NPD
• Nuvance Health Medical Practice PC

  • Internal Medicine Physician
  • Poughkeepsie, NY
  • NPI 1437358033

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Fresh Meadows Physician Practice PLLC

  • Internal Medicine Physician
  • Jamaica, NY
  • NPI 1720775083
  Medicare reassignment NPD
• Peyman Younesi MD PLLC

  • Internal Medicine Physician
  • Fresh Meadows, NY
  • NPI 1891053328
  Medicare reassignment NPD
• Health Quest Medical Practice, PC

  • Diagnostic Radiology Physician
  • Kingston, NY
  • NPI 1558906610
  NPD

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

• Vassar Brothers Hospital

  • General Acute Care Hospital
  • Poughkeepsie, NY
  • NPI 1740233899
  Care Compare affiliation
• Vassar Brothers Medical Center

  • Clinical Medical Laboratory
  • Poughkeepsie, NY
  • NPI 1780052514

  Hospital

  Care Compare affiliation
• Wellbound II LLC

  • Home Health Agency
  • Brooklyn, NY
  • NPI 1689308728
  Care Compare affiliation

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

{
    "created_epoch": "1674432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750032000000",
    "number": "1689389868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6136 170TH ST APT M4",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113651957",
            "telephone_number": "845-297-3913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 READE PL",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126013947",
            "telephone_number": "917-504-6635"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6136 170th St Apt M4",
            "address_purpose": "LOCATION",
            "city": "Fresh Meadows",
            "state": "NY",
            "postal_code": "113651957",
            "country_code": "US",
            "telephone_number": "845-297-3913",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "838 Fair St",
            "address_purpose": "LOCATION",
            "city": "Carmel",
            "state": "NY",
            "postal_code": "105123085",
            "country_code": "US",
            "telephone_number": "845-878-4111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Grant Ave",
            "address_purpose": "LOCATION",
            "city": "Lake Katrine",
            "state": "NY",
            "postal_code": "124495340",
            "country_code": "US",
            "telephone_number": "845-366-3500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "RYAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-23",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "170263",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "639923",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "10962",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "310895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Crystal Renee' Walker
• Elaine Hanglen Walker
• Shannon Nicole Walker, RN
• Deon Wallace
• Lee Ann Wallen, RN
• Amanda M Walsh
• Darby James Walsh, LCSWR
• Jean M Walsh, FNP
• Shannon Walsh, LMHC

• Adult Health Nurse Practitioner in Poughkeepsie, NY
• Providers in Poughkeepsie, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2025; 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.