Matthew Evan Wallace, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

NP95010225 Issued in CA

Practice address

200 W Arbor Dr
San Diego, CA 92103-9000

Phone

(619) 306-5855

NPI assigned

Sep 14, 2018

Sex

Male

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 CA

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Reznik Medical GroupGroup PAC ID 2961758123, 5 clinicians

Scripps Health Inpatient Providers Medical Group IncGroup PAC ID 9436314762, 209 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Scripps Mercy Hospital Hospital, San Diego, CA, CCN 050077

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Scripps Health Inpatient Providers Medical Group Inc.

  • Multi-Specialty Clinic/Center
  • La Jolla, CA
  • NPI 1699043000
  Medicare reassignment Care Compare group NPD
• Reznik Medical Group

  • Internal Medicine Physician
  • National City, CA
  • NPI 1659873842
  Medicare reassignment Care Compare group
• Regents of the University of California

  • Surgery Physician
  • San Diego, CA
  • NPI 1740382993

  Nurse Practitioner

  Medicare reassignment NPD
• Regents of the University of California

  • Diagnostic Radiology Physician
  • San Diego, CA
  • NPI 1558463927
  NPD
• Scripps Health

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1659359446
  NPD

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

• Scripps Health

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1659359446
  Care Compare affiliation

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

{
    "created_epoch": "1536883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544400000000",
    "number": "1881177806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232410",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921932410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921039000",
            "telephone_number": "619-306-5855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MATTHEW",
        "middle_name": "EVAN",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-14",
        "last_updated": "2018-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "NP95010225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• La Tanya Wallace, FNP
• Lila Wallace
• Lina Wallace
• Lucy Wallace
• Mark S Wallace, MD
• Melissa Wallace, PHARMD
• Miles Thomas Wallace, IDC
• Nicolai Lynge Wallace, MD
• Nicole Wallace, DPT
• Olivia May Wallace

• Nurse Practitioner in San Diego, CA
• Providers in San Diego, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2018; 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.