Colleen Wallace

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

11011114 Issued in FL

Practice address

287 S Central Ave
Umatilla, FL 32784-8411

Phone

(352) 747-0747

NPI assigned

Jan 11, 2021

Last updated

Jan 21, 2021By the provider in NPPES

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

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

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• Pinnacle Home Care of the Villages Inc Home health agency, The Villages, FL, CCN 109702
• Adventhealth Waterman Hospital, Tavares, FL, CCN 100057

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wallace Health, LLC

  • Adult Health Nurse Practitioner
  • Umatilla, FL
  • NPI 1598356289
  Medicare reassignment NPD Authorized official

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

• Florida Hospital Waterman Inc

  dba AdventHealth Waterman

  • General Acute Care Hospital
  • Tavares, FL
  • NPI 1821019571
  Care Compare affiliation
• Pinnacle Home Care of the Villages LLC

  • Home Health Agency
  • The Villages, FL
  • NPI 1982933321
  Care Compare affiliation

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

{
    "created_epoch": "1610323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1992394423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2485",
            "city": "UMATILLA",
            "state": "FL",
            "postal_code": "327842485",
            "telephone_number": "352-551-9404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "287 S CENTRAL AVE",
            "city": "UMATILLA",
            "state": "FL",
            "postal_code": "327848411",
            "telephone_number": "352-747-0747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "COLLEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-11",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "FL",
            "license": "11011114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "wallacehealthcares4u@gmail.com",
            "affiliation": "N",
            "endpointDescription": "business secure email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "287 S Central Ave",
            "city": "Umatilla",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327848411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Umatilla Optical & Hearing Aid Center Inc (Kathleen Bastone)
• Umatilla Optical and Hearing Aid Center, Inc
• Umatilla Pharmacy Inc (Umatilla Pharmacy)
• Jordan Andrew Walker, PA-C
• Wallace Health, LLC
• Michele L Walsh, LMFT
• Briana Whitsitt
• Stephenie Jo Wolford-Ward, LMT, LMHC
• Veronica C Wright, ARNP

• Adult Medicine Physician in Umatilla, FL
• Providers in Umatilla, FL by specialty
• Adult Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 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.