1. Home
  2. Directory
  3. Virginia
  4. Charlottesville
  5. Nurse Practitioner
  6. NPI Profile

JESSE L WALLACE AG-ACNP
NPI 1013697267
Nurse Practitioner - Acute Care in Charlottesville, VA

Active since July 24, 2023PECOS EnrolledAccepts Medicare Assignment
500 MARTHA JEFFERSON DR STE 505, CHARLOTTESVILLE, VA 22911(434) 654-5260(434) 654-5261 Get Directions Write a Review

NPPES record last updated: May 11, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 11, 2026, Dec 6, 2024, Jul 24, 2023 (3 updates tracked since 2023).

About Jesse L Wallace Ag-acnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JESSE L WALLACE AG-ACNP (NPI 1013697267) is an individual acute care provider in Charlottesville, Virginia, licensed in Virginia (0024187479) and active in the NPI registry since July 2023. He is enrolled in Medicare PECOS, is affiliated with University Of Virginia Medical Center, and maintains a secondary practice location in Charlottesville.

NPPES Registry Identity

NPI1013697267
Entity TypeIndividualMale
Primary Taxonomy363LA2100X
Provider Legal NameJESSE L WALLACECredential: AG-ACNP
Location Address500 MARTHA JEFFERSON DR STE 505Charlottesville, VA 22911-4668
Mailing Address500 Martha Jefferson Dr Ste 505Charlottesville, VA 22911-4668 · (434) 654-5260 · Fax (434) 654-5261
Phone(434) 654-5260
Fax(434) 654-5261
Sole ProprietorNo
Medical School CMSOtherGraduated 2023
Enumeration DateJuly 24, 2023
Last NPPES UpdateMay 11, 20263 updates tracked since enumeration
NPPES CertifiedMay 11, 2026
✔ NPI 1013697267 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
License✔ Licensed in VA · 0024187479
Also ListedAnesthesiology · Critical Care MedicineTaxonomy 207LC0200X · License 0024187479 (VA)
500 MARTHA JEFFERSON DR STE 505, Charlottesville, VA 22911
Open in Google Maps ↗

Secondary Practice Location 1

Location 11215 Lee StCharlottesville, VA 22908-0816 · Phone (434) 924-3627

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jesse L Wallace Ag-acnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7416487731
PECOS Enrollment IDI20250214002795
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

University Of Virginia Medical Center

Acute Care Hospitals · Charlottesville, VA
4/5 CMS rating
OwnershipGovernment - State
CMS Certification Number490009
Location1215 Lee StreetCharlottesville, VA 22908 · Charlottesville City County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 22911 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$86.88 typical visit price
range $56.19 – $170.30
Typical copayment $21.72 (range $14.04 – $42.57)
Most-billed visit code 99203
Established Patient
$99.13 typical visit price
range $18.07 – $138.91
Typical copayment $24.78 (range $4.51 – $34.72)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NADIA MUSTAFA ALQURINI MD
Internal Medicine (Nephrology)
500 MARTHA JEFFERSON DR STE 505
CHARLOTTESVILLE, VA 22911
Albemarle County (434) 654-5260

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jesse Wallace's NPI number?

The NPI number for Jesse Wallace is 1013697267. It was assigned to this individual provider in the NPPES registry on July 24, 2023.

Where is Jesse Wallace located?

Jesse Wallace practices at 500 Martha Jefferson Dr Ste 505, Charlottesville, VA 22911. The listed phone number is (434) 654-5260.

What is Jesse Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Is Jesse Wallace enrolled in Medicare?

Yes. Jesse Wallace is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Jesse Wallace affiliated with any hospitals?

According to CMS data, Jesse Wallace is affiliated with University Of Virginia Medical Center.

When was this NPI record last updated?

The NPPES record for Jesse Wallace was last updated on May 11, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.