Patricia Sue Wallace, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3012119 Issued in KY

Practice address

496 Southland Dr
Lexington, KY 40503-1827

Phone

(859) 288-2425

Fax

(859) 288-7510

NPI assigned

Mar 20, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kiosk Medicine Kentucky LLCGroup PAC ID 6002887510, 169 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

83.72 of 100Reported as group

Quality

66.02

Promoting interoperability

100

Improvement activities

40

Cost

79.72

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: patricia.wallace@krogerhealth.eclinicaldirectplus.com
• Direct secure messaging: patricia.wallace.1@32600.direct.athenahealth.com

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.

• Kiosk Medicine Kentucky LLC

  • Family Nurse Practitioner
  • Louisville, KY
  • NPI 1205885035
  Medicare reassignment Care Compare group NPD
• Healthfirst Bluegrass Inc

  • Federally Qualified Health Center (FQHC)
  • Lexington, KY
  • NPI 1114932514
  Medicare reassignment NPD
• Healthfirst Bluegrass Inc.

  • Federally Qualified Health Center (FQHC)
  • Lexington, KY
  • NPI 1447997044
  NPD

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

{
    "created_epoch": "1521504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668643200000",
    "number": "1730683301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "496 SOUTHLAND DR",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405031827",
            "telephone_number": "859-288-2425",
            "fax_number": "859-288-7510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "496 SOUTHLAND DR",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405031827",
            "telephone_number": "859-288-2425",
            "fax_number": "859-288-7510"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1650 Bryan Station Rd",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405052138",
            "country_code": "US",
            "telephone_number": "859-977-2096",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "122 Arceme Ave",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405053502",
            "country_code": "US",
            "telephone_number": "859-288-2425",
            "fax_number": "859-288-7510",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "615 E Brannon Rd",
            "address_purpose": "LOCATION",
            "city": "Nicholasville",
            "state": "KY",
            "postal_code": "403567918",
            "country_code": "US",
            "telephone_number": "859-278-5007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "PATRICIA",
        "middle_name": "SUE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-20",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3012119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerald Payden Wallace, M.D.
• Julie Bourne Wallace, M.A., CCC/SLP
• Kellie L Wallace, RN, MSN
• Madison Wallace, LPCC
• Matthew Richard Wallace, DNP, APRN, PMHNP-BC
• Thomas Everett Wallace, M.D.
• William Robert Wallace, M.D.
• Joyce Anne Wallen, M.ED.
• Shawna Wallen, RPH
• Peter M Wallenhorst, M.D.

• Family Nurse Practitioner in Lexington, KY
• Providers in Lexington, KY by specialty
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 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.