Jennifer Marie Wallace, NURSE PRACTITIONER

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

26NJ01341100 Issued in NJ

Practice address

202 Cabot CT
Deptford, NJ 08096-5114

Phone

(856) 885-4579

NPI assigned

Aug 2, 2022

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 NJ

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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Nurse Practitioner Professional ResourcesGroup PAC ID 1951450931, 12 clinicians

Senior Healthcare Outreach ProgramGroup PAC ID 5890893713, 12 clinicians

Salerno Medical Associates, LLCGroup PAC ID 3678676434, 38 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Promise Care NJ Home health agency, East Orange, NJ, CCN 317009
• Carewell Health Medical Center Hospital, East Orange, NJ, CCN 310083

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/26288/brand/1/csg/1/fhir/r4
• FHIR API: https://api.platform.athenahealth.com/13207/brand/1/csg/1/fhir/r4
• Direct secure messaging: jennifer.wallace.1@26288.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.

• Nurse Practitioner Professional Resources

  • Adult Health Nurse Practitioner
  • Blackwood, NJ
  • NPI 1558516260
  Medicare reassignment Care Compare group NPD
• Salerno Medical Associates, LLC

  • Internal Medicine Physician
  • East Orange, NJ
  • NPI 1184766107
  Medicare reassignment Care Compare group NPD
• Senior Healthcare Outreach Program

  • Geriatric Medicine (Internal Medicine) Physician
  • East Orange, NJ
  • NPI 1588707954
  Medicare reassignment Care Compare group NPD
• North Ward Medical Arts LLC

  • Internal Medicine Physician
  • Newark, NJ
  • NPI 1538790563
  NPD (past)

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

• Eoh Acquisition Group, LLC

  • General Acute Care Hospital
  • East Orange, NJ
  • NPI 1013386143
  Care Compare affiliation
• Promise Care of Essex County LLC

  • Home Health Agency
  • East Orange, NJ
  • NPI 1962983379
  Care Compare affiliation

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

{
    "created_epoch": "1659398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1790412591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 WALKER RD",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070524403",
            "telephone_number": "973-715-5586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 CABOT CT",
            "city": "DEPTFORD",
            "state": "NJ",
            "postal_code": "080965114",
            "telephone_number": "856-885-4579"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "36 Walker Rd",
            "address_purpose": "LOCATION",
            "city": "West Orange",
            "state": "NJ",
            "postal_code": "070524403",
            "country_code": "US",
            "telephone_number": "973-715-5586",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "36 Walker Rd",
            "address_purpose": "LOCATION",
            "city": "West Orange",
            "state": "NJ",
            "postal_code": "070524403",
            "country_code": "US",
            "telephone_number": "973-715-5586",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-02",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NJ",
            "license": "26NJ01341100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Von Lange
• Kelli A Wade, MSW, LCSW
• Wal-Mart Pharmacy Store 3422
• Wal-Mart Stores East LP
• Wal-Mart Stores, Inc.
• Kaitlyn Weatherby, PT, DPT
• Welcare Pediatrics LLC
• Tammy Woods
• Tiffany Wright
• Ulysses Wing Yau, O.D.

• Gerontology Nurse Practitioner in Deptford, NJ
• Providers in Deptford, NJ by specialty
• Gerontology Nurse Practitioner in New Jersey

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