Jennifer M Wallace, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9104356 Issued in FL

Practice address

620 10TH St N Ste 1D
St Petersburg, FL 33705-1407

Phone

(727) 828-8400

Fax

(727) 333-6435

NPI assigned

Oct 5, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

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, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baycare Medical Group, Inc.Group PAC ID 6406753623, 1,539 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Anthonys Hospital Hospital, Saint Petersburg, FL, CCN 100067

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: jennifer.wallacepac@direct.mybaycare.org

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.

• Baycare Medical Group, Inc.

  • General Practice Physician
  • Clearwater, FL
  • NPI 1043269871

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• Emergency Medicine Services of FL, LLC

  • Emergency Medicine Physician
  • Aventura, FL
  • NPI 1043917180
  Medicare reassignment
• Baycare Medical Group, Inc.

  • Family Medicine Physician
  • Clearwater, FL
  • NPI 1659720837
  NPD

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

• St. Anthonys Hospital, Inc.

  • General Acute Care Hospital
  • St Petersburg, FL
  • NPI 1427024942
  Care Compare affiliation

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741910400000",
    "number": "1972791747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2995 DREW ST FL 2",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337593012",
            "telephone_number": "727-315-7496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 10TH ST N STE 1D",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337051407",
            "telephone_number": "727-828-8400",
            "fax_number": "727-333-6435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-05",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9104356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292900700",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Jennifer.WallacePAC@direct.mybaycare.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "620 10th St N Ste 1D",
            "city": "St Petersburg",
            "state": "FL",
            "country_code": "US",
            "postal_code": "337051407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kimberly Wall, CRT
• Weston Wall, MD
• Anna Joan Wallace, COTA
• Jennifer L Wallace, P.T.
• Jennifer Lea Wallace, PAC
• Kristie Jackson Wallace, PHARMD
• Kristin Elise Wallace, LMHC
• Ora Wallace
• Robert Jennings Wallace, MD
• Sheri Anne Wallace, NBCHWC

• Surgical Physician Assistant in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 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.