Mikaela Wallace, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

T2287 Issued in TX

Practice address

7301 Milwaukee Ave
Lubbock, TX 79424-0626

Phone

(806) 761-0464

Fax

(806) 698-6710

NPI assigned

Jun 10, 2018

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

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Texas Tech University Health Science Center School of Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Umc PhysiciansGroup PAC ID 9830003631, 107 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University Medical Center Hospital, Lubbock, TX, CCN 450686

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mikaela.wallace1@direct.myteamcare.com
• Direct secure messaging: mwallace1930195@oc.providencedirect.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.

• Umc Physicians

  • Family Medicine Physician
  • Lubbock, TX
  • NPI 1669418547
  Medicare reassignment Care Compare group NPD
• Lubbock County Hospital District

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1508855578
  NPD (past)

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

• Lubbock County Hospital District

  • Land Ambulance
  • Lubbock, TX
  • NPI 1174620546

  Hospital

  Care Compare affiliation
• Lubbock County Hospital District

  • Ambulatory Surgical Clinic/Center
  • Lubbock, TX
  • NPI 1538245717

  Hospital

  Care Compare affiliation
• Lubbock County Hospital District

  • Community/Retail Pharmacy
  • Lubbock, TX
  • NPI 1679521652

  Hospital

  Care Compare affiliation
• Lubbock County Hospital District

  • General Acute Care Hospital
  • Lubbock, TX
  • NPI 1821087164
  Care Compare affiliation
• Lubbock County Hospital District

  • Hearing and Speech Clinic/Center
  • Lubbock, TX
  • NPI 1831299114

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1528588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1992298467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5219 CITY BANK PKWY STE 35",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794073545",
            "telephone_number": "806-761-0334",
            "fax_number": "806-785-0872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7301 MILWAUKEE AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794240626",
            "telephone_number": "806-761-0464",
            "fax_number": "806-698-6710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MIKAELA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-10",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "T2287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mikaela.Wallace1@direct.myteamcare.com",
            "affiliation": "Y",
            "affiliationName": "UMC Physicians",
            "address_1": "7301 Milwaukee Ave",
            "city": "Lubbock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "794240626",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Teryn J'Nae Walker, PHARM.D.
• Trevor Walker, M.D.
• Jalyn Wall, CFNP
• Allen Wallace
• Kristi Wallace, RBT
• Sydney Laine Waller
• Connor Walp
• Courtney E Walraven, LCSW
• David Russell Walt, PT
• Paul David Walter, MD

• Family Medicine Physician in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; 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.