Katie Justine Wallace, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN2264353 Issued in MA

Practice address

Mashpee Family Medicine 5 Industrial Drive
Suite 100
Mashpee, MA 02649

Phone

(508) 477-4282

Fax

(508) 539-6134

NPI assigned

Aug 11, 2015

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

Medicare fee-for-service enrollment

Enrolled in MA

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pembroke Medical Associates IncGroup PAC ID 3678992955, 26 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beth Israel Deaconess Hospital Plymouth Hospital, Plymouth, MA, CCN 220060

Merit-based Incentive Payment System (MIPS)

Final score

76.23 of 100Reported as group

Quality

56.78

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

95.37 of 100Reported as group

Quality

83.26

Promoting interoperability

100

Improvement activities

40

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.

• Pembroke Medical Associates Inc

  • Internal Medicine Physician
  • Pembroke, MA
  • NPI 1194332759
  Medicare reassignment Care Compare group
• Medical Affiliates of Cape Cod, Inc.

  • Internal Medicine Physician
  • Hyannis, MA
  • NPI 1770534927
  Medicare reassignment NPD
• Physicians of Falmouth Hospital

  • Internal Medicine Physician
  • Falmouth, MA
  • NPI 1821363698

  Nurse Practitioner

  Medicare reassignment NPD
• Pai Participant Ma PC

  • Geriatric Medicine (Internal Medicine) Physician
  • East Boston, MA
  • NPI 1932984317
  Medicare reassignment
• Medical Affiliates of Cape Cod, Inc.

  • Ambulatory Surgical Clinic/Center
  • Mashpee, MA
  • NPI 1306391206
  NPD

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

• Beth Israel Deaconess Hospital Plymouth, Inc.

  • General Acute Care Hospital
  • Plymouth, MA
  • NPI 1043299001
  Care Compare affiliation

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

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451865600000",
    "number": "1790151967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 INDUSTRIAL DRIVE, MASHPEE FAMILY MEDICINE",
            "address_2": "SUITE 100",
            "city": "MASHPEE",
            "state": "MA",
            "postal_code": "026493544",
            "telephone_number": "508-477-4282",
            "fax_number": "508-539-6134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MASHPEE FAMILY MEDICINE 5 INDUSTRIAL DRIVE",
            "address_2": "SUITE 100",
            "city": "MASHPEE",
            "state": "MA",
            "postal_code": "02649",
            "telephone_number": "508-477-4282",
            "fax_number": "508-539-6134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KATIE",
        "middle_name": "JUSTINE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-11",
        "last_updated": "2016-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN2264353",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN2264353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Anna Vasconcellos, RD, CDE, LDN
• Janet L Vecchione, RDN, LDN, CDCES
• Kathryn A Wagner
• Walgreen Co
• Walgreens
• Jessica Walsh
• Ambrosia Ward
• Warm-Hearted Care LLC
• Brian Keith Washington Sr., LADC
• Matthew Waterbury, O.D.

• Family Nurse Practitioner in Mashpee, MA
• Providers in Mashpee, MA by specialty
• Family Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2016; 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.