Cynthia Catherine Wallace, P.A.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9114207 Issued in FL

Practice address

5070 Highway A1A Ste a
Vero Beach, FL 32963-1229

Phone

(954) 531-9433

NPI assigned

Jul 21, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, FL2 enrollments

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 2

Specialty

Physician Assistant

Education

Nova Southeastern College of Osteo Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Facial Cosmetic and Laser Surgery Center, LLCGroup PAC ID 0244414720, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: cwallace@directaddress.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.

• Advanced Facial Cosmetic & Laser Surgery Center, LLC

  • Plastic Surgery Physician
  • Vero Beach, FL
  • NPI 1003111923
  Medicare reassignment Care Compare group
• Advanced Facial Cosmetic & Laser Surgery Center Inc

  • Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
  • Vero Beach, FL
  • NPI 1083645717
  NPD (past)

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

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1730596875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5070 HIGHWAY A1A STE A",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329631229",
            "telephone_number": "954-531-9433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5070 HIGHWAY A1A STE A",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329631229",
            "telephone_number": "954-531-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CYNTHIA",
        "middle_name": "CATHERINE",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-21",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MD",
            "license": "C0005406",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9114207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Jalia Walker, HHA
• Kelly Elizabeth Walker, LMT
• Odane Walker
• Lisa Laura Wall, PA
• Wilson King Wallace, MD
• Conor Walsh, PHARMD
• Laura Leigh Walsh, PA
• Piper Walsh, LMHC
• Patricia Pinaya Walters, MD

• Surgical Physician Assistant in Vero Beach, FL
• Providers in Vero Beach, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; 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.