Kelleyayn Wallace, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

011509 Issued in NY

Practice address

2080 Clinton Ave South
Rochester, NY 14618

Phone

(585) 271-2800

Fax

(585) 271-0375

NPI assigned

Sep 26, 2006

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 identifiers 5

Medicare fee-for-service enrollment

Enrolled in NY

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

Physician Assistant

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Texas Digestive Disease Consultants, PLLCGroup PAC ID 3375531379, 616 clinicians

Internal Medicine GroupGroup PAC ID 3476454661, 166 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Strong Memorial Hospital Hospital, Rochester, NY, CCN 330285
• Highland Hospital Hospital, Rochester, NY, CCN 330164

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Internal Medicine Group

  • Internal Medicine Physician
  • Rochester, NY
  • NPI 1649220393
  Medicare reassignment Care Compare group NPD
• Texas Digestive Disease Consultants PLLC

  • Gastroenterology Physician
  • Rochester, NY
  • NPI 1568283422
  Medicare reassignment Care Compare group NPD

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

• Highland Hospital of Rochester

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1972548568
  Care Compare affiliation
• University of Rochester

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1346285657
  Care Compare affiliation
• University of Rochester

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1669126090
  Care Compare affiliation

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449619200000",
    "number": "1831290717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 CLINTON AVE SOUTH",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "14618",
            "telephone_number": "585-271-2800",
            "fax_number": "585-271-0375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CLINTON AVE SOUTH",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "14618",
            "telephone_number": "585-271-2800",
            "fax_number": "585-271-0375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KELLEYAYN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2015-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "011509",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CF8438",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7082043",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS",
            "identifier": "G0183898590",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02578343",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1366535940",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Treana Wall, LPN
• Tanya Wallace-Farquharson, PHD, MSN, RN
• Danielle Schenone Wallace, M.D
• Hilary Wallace, LCAT-LP
• Jackie Wallace, CRPA
• Lisa Michelle Wallace, DDS
• Maxwell Wallace, PSYD
• Meghan Elizabeth Wallace, LMSW
• Lisa Wallin, ANP-C, CWS
• Ian William Wallis, MD

• Physician Assistant in Rochester, NY
• Providers in Rochester, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2015; 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.