Rafaella Izar Wallace, ANP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

AP129253 Issued in TX

Practice address

500 S Henderson St Ste 200
Fort Worth, TX 76104-2154

Phone

(817) 413-1500

Fax

(817) 413-1499

NPI assigned

Oct 13, 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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Texas Oncology PAGroup PAC ID 5395658934, 1,001 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

85.12 of 100Reported as apm

Quality

67.48

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rafaella.wallace@txo.ikm.direct-ci.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.

• Texas Oncology PA

  • Medical Oncology Physician
  • El Paso, TX
  • NPI 1811944101
  Medicare reassignment Care Compare group NPD
• Texas Digestive Disease Consultants, PLLC

  • Gastroenterology Physician
  • Irving, TX
  • NPI 1053397331
  Medicare reassignment NPD
• Texas Digestive Disease Consultants, PLLC

  • Gastroenterology Physician
  • Southlake, TX
  • NPI 1649256546
  NPD
• Texas Oncology PA

  • Medical Oncology Physician
  • Dallas, TX
  • NPI 1003083445
  NPD
• Texas Oncology PA

  • Medical Oncology Physician
  • Pearland, TX
  • NPI 1912174350
  NPD
• Texas Digestive Disease Consultants PLLC

  • Gastroenterology Physician
  • Covington, LA
  • NPI 1295428415
  NPD

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

{
    "created_epoch": "1444694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1821469107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 911230",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753911230",
            "telephone_number": "972-997-8000",
            "fax_number": "972-234-2987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S HENDERSON ST STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042154",
            "telephone_number": "817-413-1500",
            "fax_number": "817-413-1499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "RAFAELLA",
        "middle_name": "IZAR",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-13",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "AP129253",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "AP129253",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "365509402",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8449NZ",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Lynette Wallace, MSN, APRN, FNP-C,
• Bethany Wallace, LCSW
• Cristy L Wallace, FNP
• Gabriel Wallace
• Paige Marie Wallace
• Rane Perry Wallace, MS, LPC, LCDC, SAP
• Taron M Wallace, M.S., CCC-SLP
• Emily Wallen, MA, LPC
• Charles F. Waller, CRNA
• Katelyn D'Ann Walley, PTA

• Gerontology Nurse Practitioner in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Gerontology Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; 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.