Marissa Leanne Wallace, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F308236 Issued in NY

Practice address

3078 Route 9W Ste 100
New Windsor, NY 12553-6751

Phone

(845) 561-3310

Fax

(845) 561-8728

NPI assigned

May 1, 2012

Sex

Female

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 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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nuvance Health Medical Practice PCGroup PAC ID 1658468442, 578 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Vassar Brothers Medical Center Hospital, Poughkeepsie, NY, CCN 330023
• Montefiore St Luke'S Cornwall Hospital, Newburgh, NY, CCN 330264

Merit-based Incentive Payment System (MIPS)

Final score

81.38 of 100Reported as group

Quality

63.01

Promoting interoperability

98

Improvement activities

40

Cost

72.3

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Nuvance Health Medical Practice PC

  • Internal Medicine Physician
  • Poughkeepsie, NY
  • NPI 1437358033
  Medicare reassignment Care Compare group NPD
• New York Surgicalist Services, P.C.

  • Surgery Physician
  • Newburgh, NY
  • NPI 1720663768
  Medicare reassignment NPD
• Acute Care Surgery Medical Group, Inc.

  • Surgery Physician
  • Sacramento, CA
  • NPI 1700069549

  NY

  Medicare reassignment NPD

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

• St. Luke'S Cornwall Hospital

  • General Acute Care Hospital
  • Newburgh, NY
  • NPI 1003923434
  Care Compare affiliation
• 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

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

{
    "created_epoch": "1335830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1689932360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3078 ROUTE 9W",
            "address_2": "SUITE 100",
            "city": "NEW WINDSOR",
            "state": "NY",
            "postal_code": "12553",
            "telephone_number": "845-561-3310",
            "fax_number": "845-561-8728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3078 ROUTE 9W STE 100",
            "city": "NEW WINDSOR",
            "state": "NY",
            "postal_code": "125536751",
            "telephone_number": "845-561-3310",
            "fax_number": "845-561-8728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MARISSA",
        "middle_name": "LEANNE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-01",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "653689-1",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F308236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzanne Vizethann, LCSW
• Anuj Vohra, DO
• Brenda Vreeland
• Beth Ailene Waldo, LCSW
• Walgreen Co
• Elizabeth Walsh, PMHNP
• Warrior Service Company LLC
• Mary Ellen Washburn, MSW LCSW
• Waterfront Dental PLLC
• Harshan I Weerackody, MD FACC

• Adult Health Nurse Practitioner in New Windsor, NY
• Providers in New Windsor, 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 Jul 21, 2022; 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.