DR. ROBERT D WALLACE MD
NPI 1023075637
Surgery - Plastic and Reconstructive Surgery in Memphis, TN

Q: What is Robert Wallace's NPI number?

The NPI number for Robert Wallace is 1023075637. It was assigned to this individual provider in the NPPES registry on April 27, 2006.

Q: What is Robert Wallace's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

Q: When was this NPI record last updated?

The NPPES record for Robert Wallace was last updated on February 1, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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 April 27, 2006PECOS EnrolledAccepts Medicare Assignment

1068 CRESTHAVEN RD STE 500, MEMPHIS, TN 38119(901) 866-8525 Get Directions Write a Review

NPPES record last updated: February 1, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 1, 2019, Mar 29, 2018 (2 updates tracked since 2018).

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About Dr. Robert D Wallace Md NPPES

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

DR. ROBERT D WALLACE MD (NPI 1023075637) is an individual plastic and reconstructive surgery provider in Memphis, Tennessee, licensed in Tennessee (27658) and active in the NPI registry since April 2006. He is enrolled in Medicare PECOS, is affiliated with Baptist Memorial Hospital, and maintains a secondary practice location in Memphis.

NPPES Registry Identity

NPI1023075637

Entity TypeIndividualMale

Primary Taxonomy2086S0122X

Provider Legal NameDR. ROBERT D WALLACECredential: MD

Location Address1068 CRESTHAVEN RD STE 500Memphis, TN 38119

Mailing Address1407 Union Ave Ste 700Memphis, TN 38104-3641 · (901) 866-8622

Phone(901) 866-8525

Sole ProprietorNo

Medical School CMSJefferson Medical College Of Thomas Jefferson UniversityGraduated 1984

Enumeration DateApril 27, 2006

Last NPPES UpdateFebruary 1, 20192 updates tracked since enumeration

✔ NPI 1023075637 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code2086S0122X

License✔ Licensed in TN · 27658

Definition

A surgeon who specializes in plastic and reconstructive surgery.

1068 CRESTHAVEN RD STE 500, Memphis, TN 38119

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Secondary Practice Location 1

Location 11910 Nonconnah Blvd, Suite 120Memphis, TN 38132-2113 · Phone (901) 448-2300 · Fax (901) 448-6657

Other Identifiers 3

Medicaid130322001AR

Medicaid3804973TN

Medicaid00118676MS

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BlueCross BlueShield of Tennessee, Oscar Health Plan, Inc., Oscar Insurance Company.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

Dr. Robert D Wallace Md 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 ID6608068234

PECOS Enrollment IDI20101014000191

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.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

52 services52 patients

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

38 services35 patients

Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less 14060

This procedure involves repairing a wound on the eyelids, nose, ears, or lips by moving a small piece of skin (10.0 sq cm or less) from one area to another. The goal is to heal the wound and restore the function and appearance of the affected area.

20 services19 patients

Hospital Affiliations CMS Care Compare

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

Baptist Memorial Hospital

Acute Care Hospitals · Memphis, TN

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number440048

Location6019 Walnut Grove RoadMemphis, TN 38120 · Shelby County

Emergency services Birthing friendly

Other Providers at the Same Location NPPES 15

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

DR. DANI KRUCHEVSKY MD

Surgery (Plastic and Reconstructive Surgery)