MR. MARIO JAMES WALLACE PT, DPT
NPI 1043064009
Physical Therapist - Orthopedic in New York, NY
About Mr. Mario James Wallace Pt, Dpt NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. MARIO JAMES WALLACE PT, DPT (NPI 1043064009) is an individual orthopedic provider in New York, New York, licensed in New York (052204) and active in the NPI registry since April 2024. He maintains a secondary practice location in New York and is a graduate of Other (2024).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Mr. Mario James Wallace Pt, Dpt 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.
Medicare Billing Reassignments
2Medicare enrollment records show Mario Wallace reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
New York, NY 10022
- Reassigned Medicare billing, New York enrollment
- 706 clinicians in this Medicare group
Brooklyn, NY 11229
- Reassigned Medicare billing, New York enrollment
- 446 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 6
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.
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.
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 Mario Wallace's NPI number?
The NPI number for Mario Wallace is 1043064009. It was assigned to this individual provider in the NPPES registry on April 16, 2024.
Where is Mario Wallace located?
Mario Wallace practices at 4246 Broadway, New York, NY 10033. The listed phone number is (646) 790-7463.
What is Mario Wallace's specialty?
The primary specialty registered for this NPI is Physical Therapist, specializing in Orthopedic, with taxonomy code 2251X0800X.
Is Mario Wallace enrolled in Medicare?
Yes. Mario 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.
Which organizations bill Medicare for Mario Wallace's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mario Wallace reassigns Medicare benefits to 2 organizations: Spear Physical And Occupational Therapy, LLC (New York, NY) and New York Physical And Occupational Therapy Services, PLLC (Brooklyn, NY). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mario Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Mario Wallace was last updated on October 14, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 days 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.
# Mr. Mario James Wallace, PT, DPT · NPI 1043064009
Orthopedic provider in New York, New York. Individual provider, active in the CMS NPPES registry since April 16, 2024.
## Identity
- **NPI:** 1043064009 (Entity type: Individual)
- **Enumerated:** April 16, 2024
- **Primary specialty:** Physical Therapist - Orthopedic · taxonomy 2251X0800X
- **State license:** 052204 (New York)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 4246 BROADWAY, New York, NY 10033-3708
- **Phone:** (646) 790-7463
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Spear Physical And Occupational Therapy, LLC (NPI 1063454577, New York, NY); New York Physical And Occupational Therapy Services, PLLC (NPI 1356703631, Brooklyn, NY) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2024
## Record status
- **NPPES last updated:** October 14, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1043064009) · Data from the CMS NPPES public registry.