Jessica Dene Wallace, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

CNM278747 Issued in AZ

Practice address

167 North Main Street
Tuba City, AZ 86045-0600

Phone

(928) 283-2501

Fax

(928) 283-2677

NPI assigned

Aug 22, 2022

Sex

Female

Sole proprietor

Yes

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 TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Certified Nurse Midwife (CNM)

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tuba City Regional Health Care CorporationGroup PAC ID 4284542531, 160 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

77.59 of 100Reported as group

Quality

47.51

Promoting interoperability

69

Improvement activities

40

Cost

86.96

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

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.

• Tuba City Regional Health Care Corporation

  • General Acute Care Hospital
  • Tuba City, AZ
  • NPI 1548294424

  TX

  Medicare reassignment Care Compare group NPD
• Tuba City Regional Health Care Corporation

  • Family Medicine Physician
  • Bodaway Gap, AZ
  • NPI 1710519913
  NPD
• Tuba City Regional Health Care Corporation

  • General Acute Care Hospital
  • Tuba City, AZ
  • NPI 1780867556
  NPD (past)

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

{
    "created_epoch": "1661126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661126400000",
    "number": "1760100028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 600",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "860450600",
            "telephone_number": "928-283-2781",
            "fax_number": "928-283-2677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 NORTH MAIN STREET",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "860450600",
            "telephone_number": "928-283-2501",
            "fax_number": "928-283-2677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JESSICA",
        "middle_name": "DENE",
        "name_prefix": "Ms.",
        "credential": "CNM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-22",
        "last_updated": "2022-08-22",
        "certification_date": "2022-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "AZ",
            "license": "CNM278747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yuriy Y Vinokur, M.D.
• Vista Care, LLC
• Kameelah Vose, RN
• Cynthia Diane Wade
• Susan Dieterle Wahl, RN
• Sean Wallace
• Joette Walters, RN
• Jason L Ward, DMD
• Jayson Watabe, P.A.
• Correna Watson

• Advanced Practice Midwife in Tuba City, AZ
• Providers in Tuba City, AZ by specialty
• Advanced Practice Midwife in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.