Heather A Wallace, DSC., PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

15336 Issued in MN

Practice address

915 E 1St St
Duluth, MN 55805-2107

Phone

(218) 249-6450

NPI assigned

Nov 7, 2012

Last updated

Dec 10, 2025By 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 8

Addresses

Other identifiers 2

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in VA, DC, NY, OH, MN5 enrollments

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 5

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. Luke's Hospital of DuluthGroup PAC ID 7113834839, 409 clinicians

St Josephs Medical PCGroup PAC ID 4688855844, 388 clinicians

United Medical Associates PCGroup PAC ID 0345144978, 229 clinicians

Urgent Specialty Associates PLLCGroup PAC ID 7618235995, 56 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Lukes Hospital Hospital, Duluth, MN, CCN 240047
• CJW Medical Center Hospital, Richmond, VA, CCN 490112

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: hwallace@direct.iuhealth.org
• Direct secure messaging: hwallace2479325@direct.trinity-health.org
• Direct secure messaging: hwallace372865@direct.aspirus.org
• Direct secure messaging: vaexchange@patientfirstclinics.com

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.

• St. Luke's Hospital of Duluth

  dba Aspirus St Lukes Hospital Inpatient Rehab

  • Rehabilitation Hospital Unit
  • Duluth, MN
  • NPI 1902845068
  Medicare reassignment Care Compare group NPD
• United Medical Associates PC

  • Clinic/Center
  • Binghamton, NY
  • NPI 1013972801
  Medicare reassignment Care Compare group NPD
• St Josephs Medical PC

  • Family Medicine Physician
  • Liverpool, NY
  • NPI 1942501747
  Medicare reassignment Care Compare group
• Urgent Specialty Associates PLLC

  • Surgery Physician
  • Richmond, VA
  • NPI 1487164604
  Medicare reassignment Care Compare group
• Patient First Richmond Medical Group PLLC

  • Family Medicine Physician
  • Glen Allen, VA
  • NPI 1689603748

  DC

  Medicare reassignment NPD
• United Health Services Hospitals, Inc.

  • Multi-Specialty Clinic/Center
  • Johnson City, NY
  • NPI 1962463851
  Medicare reassignment NPD
• University of Toledo Physicians LLC

  • Internal Medicine Physician
  • Toledo, OH
  • NPI 1942296033

  Physician Assistant

  Medicare reassignment NPD
• CG Medical Associates Inc

  • Urgent Care Clinic/Center
  • Cincinnati, OH
  • NPI 1982903951
  Medicare reassignment
• Premier Health Specialists Inc

  • Internal Medicine Physician
  • Moraine, OH
  • NPI 1194958223
  Medicare reassignment
• St. Luke's Hospital of Duluth

  dba Aspirus Palliative Medicine - Minnesota

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Duluth, MN
  • NPI 1073480968
  NPD
• St. Luke's Hospital of Duluth

  dba Aspirus St Lukes Clinic Duluth Gastroenterology

  • Gastroenterology Physician
  • Duluth, MN
  • NPI 1902850605
  NPD
• North Medical PC

  • Family Medicine Physician
  • Liverpool, NY
  • NPI 1972563070
  NPD

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

• St. Luke's Hospital of Duluth

  dba Aspirus St Lukes Clinic Duluth Grand Ave

  • Family Medicine Physician
  • Duluth, MN
  • NPI 1033161161

  Hospital

  Care Compare affiliation
• St. Luke's Hospital of Duluth

  dba Aspirus St Lukes Clinic Duluth Ear, Nose & Throat

  • Otolaryngology Physician
  • Duluth, MN
  • NPI 1033653209

  Hospital

  Care Compare affiliation
• St. Luke's Hospital of Duluth

  dba Aspirus St Lukes Clinic Duluth Endocrinology

  • Endocrinology, Diabetes & Metabolism Physician
  • Duluth, MN
  • NPI 1093769796

  Hospital

  Care Compare affiliation
• St. Luke's Hospital of Duluth

  dba Aspirus St Lukes Clinic Duluth Obstetrics & Gynecology

  • Obstetrics & Gynecology Physician
  • Duluth, MN
  • NPI 1124388723

  Hospital

  Care Compare affiliation
• St. Luke's Hospital of Duluth

  dba Aspirus St Lukes Hospital Radiology

  • Vascular & Interventional Radiology Physician
  • Duluth, MN
  • NPI 1124732110

  Hospital

  Care Compare affiliation
• St. Luke's Hospital of Duluth

  dba Aspirus St Lukes Clinic Duluth Allergy & Immunology

  • Allergy & Immunology Physician
  • Duluth, MN
  • NPI 1194779884

  Hospital

  Care Compare affiliation
• St. Luke's Hospital of Duluth

  dba Aspirus St Lukes Clinic Duluth Neurosurgery

  • Neurological Surgery Physician
  • Duluth, MN
  • NPI 1285688986

  Hospital

  Care Compare affiliation
• St. Luke's Hospital of Duluth

  dba Aspirus St Lukes Clinic Duluth Dermatology

  • Dermatology Physician
  • Duluth, MN
  • NPI 1295787380

  Hospital

  Care Compare affiliation
• St. Luke's Hospital of Duluth

  dba Aspirus St Lukes Clinic Duluth 26 E Superior St

  • Family Medicine Physician
  • Duluth, MN
  • NPI 1306870654

  Hospital

  Care Compare affiliation
• St. Luke's Hospital of Duluth

  dba Aspirus St Lukes Clinic Duluth Cardiology

  • Cardiovascular Disease Physician
  • Duluth, MN
  • NPI 1417909870

  Hospital

  Care Compare affiliation
• St. Luke's Hospital of Duluth

  dba Aspirus St Lukes Clinic Duluth 6351 E Superior St

  • Family Medicine Physician
  • Duluth, MN
  • NPI 1497087126

  Hospital

  Care Compare affiliation
• St. Luke's Hospital of Duluth

  dba Aspirus St Lukes Clinic Duluth Oncology & Hematology

  • Hematology & Oncology Physician
  • Duluth, MN
  • NPI 1548214240

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1352246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765324800000",
    "number": "1821342106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3066 SEARS RD",
            "city": "SUGARCRK TWP",
            "state": "OH",
            "postal_code": "453707726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 E 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052107",
            "telephone_number": "218-249-6450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "620 John Paul Jones Cir",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "VA",
            "postal_code": "237082111",
            "country_code": "US",
            "telephone_number": "757-953-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3000 Arlington Ave Ste 2C",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436142595",
            "country_code": "US",
            "telephone_number": "419-383-3759",
            "fax_number": "419-383-2962",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "104 Union Ave",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132031843",
            "country_code": "US",
            "telephone_number": "315-424-0490",
            "fax_number": "315-475-0916",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 Prospect Ave",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132031807",
            "country_code": "US",
            "telephone_number": "315-448-5331",
            "fax_number": "315-448-5589",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7101 Jahnke Rd",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232254017",
            "country_code": "US",
            "telephone_number": "804-483-0000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 Goethals Dr Ste E",
            "address_purpose": "LOCATION",
            "city": "Richland",
            "state": "WA",
            "postal_code": "993523301",
            "country_code": "US",
            "telephone_number": "509-942-3095",
            "fax_number": "509-942-3097",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "33-57 Harrison St",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "NY",
            "postal_code": "137902107",
            "country_code": "US",
            "telephone_number": "607-763-6311",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1701 N Senate Blvd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462021239",
            "country_code": "US",
            "telephone_number": "317-962-0582",
            "fax_number": "317-962-2082",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5486 Indian River Rd",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234645365",
            "country_code": "US",
            "telephone_number": "757-424-2490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "HEATHER",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DSC., PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-07",
        "last_updated": "2025-12-10",
        "certification_date": "2025-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110004235",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10004010A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.007882RX",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA61359713",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "15336",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "029464",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP00742200",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085.010935",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "233690187",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300077904",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "VAExchange@patientfirstclinics.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "5486 Indian River Rd",
            "city": "Virginia Beach",
            "state": "VA",
            "country_code": "US",
            "postal_code": "234645365",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hwallace@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1701 N Senate Blvd",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462021239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amy Lynn Walkowiak, OD
• Jason T Wall, MD
• Linda Wall, RDH
• Ashley Corrine Wallace
• Gail Ann Wallace
• Janell Mae Lorton Wallace, PA-C
• Lauren Wallace, MD
• Lindsay J Wallace, APRN,CNP
• Deedra Eve Waller
• Laura Christensen Waller, M.D.

• Surgical Physician Assistant in Duluth, MN
• Providers in Duluth, MN by specialty
• Surgical Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2025; 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.