NAOMI SUSAN WALLACE NP
NPI 1013699131
Nurse Practitioner in Tyler, TX

Q: What is Naomi Wallace's NPI number?

The NPI number for Naomi Wallace is 1013699131. It was assigned to this individual provider in the NPPES registry on August 7, 2023.

Q: What is Naomi Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Naomi Wallace was last updated on August 7, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 07, 2023PECOS EnrolledAccepts Medicare Assignment

912 S FLEISHEL AVE, TYLER, TX 75701(903) 592-6901 Get Directions Write a Review

NPPES record last updated: August 7, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Naomi Susan Wallace Np NPPES

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

NAOMI SUSAN WALLACE NP (NPI 1013699131) is an individual nurse practitioner in Tyler, Texas, licensed in Texas (1128446) and active in the NPI registry since August 2023. She is enrolled in Medicare PECOS, is affiliated with Ut Health East Texas Tyler Regional Hospital, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1013699131

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameNAOMI SUSAN WALLACECredential: NP

Location Address912 S FLEISHEL AVETyler, TX 75701-2018

Mailing Address912 S Fleishel AveTyler, TX 75701-2018 · (903) 592-6901

Phone(903) 592-6901

Sole ProprietorNo

Medical School CMSOtherGraduated 2023

Enumeration DateAugust 7, 2023

NPPES CertifiedAugust 7, 2023

✔ NPI 1013699131 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in TX · 1128446

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

912 S FLEISHEL AVE, Tyler, TX 75701

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

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

Naomi Susan Wallace Np 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 ID5395108757

PECOS Enrollment IDI20230831004321

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 2

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

Ut Health East Texas Tyler Regional Hospital

Acute Care Hospitals · Tyler, TX

1/5 CMS rating

OwnershipProprietary

CMS Certification Number450083

Location1000 South Beckham AveTyler, TX 75701 · Smith County

Emergency services Birthing friendly

Ut Health East Texas Jacksonville Hospital

Acute Care Hospitals · Jacksonville, TX

OwnershipProprietary

CMS Certification Number450194

Location501 S RagsdaleJacksonville, TX 75766 · Cherokee County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 75701 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

$84.92 typical visit price

range $54.84 – $166.88

Typical copayment $21.23 (range $13.71 – $41.72)

Most-billed visit code 99203

Established Patient

$97.05 typical visit price

range $17.52 – $136.11

Typical copayment $24.26 (range $4.38 – $34.02)

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 20

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

DR. VARALAXMI BHAVANI NANNAKA M.D.

Internal Medicine (Pulmonary Disease)