Genevieve Rebecca Wallace, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

DR.0057122 Issued in CO

Practice address

1056 S 88TH St
Louisville, CO 80027-9460

Phone

(303) 442-6647

Fax

(303) 442-2696

NPI assigned

Oct 29, 2007

Last updated

Jun 2, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Jenny Rebecca Wallace Other name

Medicare fee-for-service enrollment

Enrolled in TX, CO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Dermatology

Education

University of Texas Medical School at Houston, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology Specialists of Boulder PCGroup PAC ID 3678668761, 13 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

98.3 of 100Reported as group

Promoting interoperability

98

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dermatology Specialists of Boulder, PC

  • MOHS-Micrographic Surgery Physician
  • Louisville, CO
  • NPI 1053449306

  Dermatology

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1193616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654128000000",
    "number": "1750560579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1056 S 88TH ST",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800279460",
            "telephone_number": "303-442-6647",
            "fax_number": "303-442-2696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1056 S 88TH ST",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800279460",
            "telephone_number": "303-442-6647",
            "fax_number": "303-442-2696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "GENEVIEVE",
        "middle_name": "REBECCA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-29",
        "last_updated": "2022-06-02",
        "certification_date": "2022-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "CO",
            "license": "57122",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CO",
            "license": "DR.0057122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNY",
            "last_name": "WALLACE",
            "middle_name": "REBECCA",
            "prefix": "DR.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kytja K.S. Voeller, MD
• Benjamin Vogrin, MSW
• Ashley Waggoner, DPT
• Hallie Wakely Stone, FNP-C
• Walgreen Co (Walgreens #01286)
• Judith Mary Wallace, RXN,NP
• Diana Walley, MNT
• James Richard Walsh Jr., DPT
• Wandering Sage Medicine LLC (Colorado Integrative Medicine LLC)
• Xuemei Wang

• Dermatology Physician in Louisville, CO
• Providers in Louisville, CO by specialty
• Dermatology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 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.