Tracee Marie Wallace, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA031280 Issued in DC

Practice address

5255 Loughboro Rd NW
Washington, DC 20016-2633

Phone

(202) 537-4000

NPI assigned

Aug 5, 2009

Last updated

May 1, 2023By 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 1

Addresses

Other names 1

• Ms. Tracee Marie Hermanson Former name

Medicare fee-for-service enrollment

Enrolled in DC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: twallace373077@direct.hopkinsmedicine.org

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.

• Medical Faculty Associates, Inc

  • Anesthesiology Physician
  • Washington, DC
  • NPI 1417990581
  Medicare reassignment
• Johns Hopkins University

  dba Jhu - Transplant/Vascular Surgery

  • Transplant Surgery Physician
  • Baltimore, MD
  • NPI 1124009758

  DC

  Medicare reassignment
• Johns Hopkins University

  dba JHU - 6849 Old Dominion Drive - Physician

  • Neurology Physician
  • McLean, VA
  • NPI 1598552226
  NPD
• Johns Hopkins University

  dba Jhu - Cardiac Surgery

  • Surgery Physician
  • Baltimore, MD
  • NPI 1780665315
  NPD
• Trihealth H LLC

  • Obstetrics Physician
  • Cincinnati, OH
  • NPI 1811215742
  NPD (past)

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

{
    "created_epoch": "1249430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1811128010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10551 HUNTERS WAY",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207235723",
            "telephone_number": "505-573-1388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5255 LOUGHBORO RD NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200162633",
            "telephone_number": "202-537-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TRACEE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-05",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "DC",
            "license": "PA031280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACEE",
            "last_name": "HERMANSON",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rodney T Wallace
• Samone Cache Wallace
• Sean Joseph Wallace, M.D.
• Shanalyn Wallace
• Shirrelle Wallace
• Velisa Carter Wallace
• Daniel Jay Wallach, MD
• Jennifer Wallach
• Ally Athumani Walle Sr.
• Varvara Walle

• Surgical Physician Assistant in Washington, DC
• Providers in Washington, DC by specialty
• Surgical Physician Assistant in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.