DR. KEVIN R WALLACE DMD
NPI 1053423285
Dentist - General Practice in Chicago, IL

Q: What is Kevin Wallace's NPI number?

The NPI number for Kevin Wallace is 1053423285. It was assigned to this individual provider in the NPPES registry on September 1, 2006.

Q: What is Kevin Wallace's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Kevin Wallace was last updated on January 19, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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 September 01, 2006PECOS Enrolled

150 E HURON ST, STE 1103, CHICAGO, IL 60611(312) 676-9893(815) 744-7059 Get Directions Write a Review

NPPES record last updated: January 19, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 19, 2021, Jul 27, 2018, Jan 31, 2017 and 4 more (7 updates tracked since 2016).

On this page

About Dr. Kevin R Wallace Dmd NPPES

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

DR. KEVIN R WALLACE DMD (NPI 1053423285) is an individual general practice provider in Chicago, Illinois, licensed in Illinois (019022339) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS, is affiliated with Northwestern Lake Forest Hospital, and is a graduate of Other (1990).

NPPES Registry Identity

NPI1053423285

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameDR. KEVIN R WALLACECredential: DMD

Location Address150 E HURON ST, STE 1103Chicago, IL 60611

Mailing Address14831 W 159th St Ste 1Lockport, IL 60491-9008 · (630) 324-5369 · Fax (815) 744-7059

Phone(312) 676-9893

Fax(815) 744-7059

Sole ProprietorNo

Medical School CMSOtherGraduated 1990

Enumeration DateSeptember 1, 2006

Last NPPES UpdateJanuary 19, 20217 updates tracked since enumeration

NPPES CertifiedJanuary 19, 2021

✔ NPI 1053423285 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in IL · 019022339

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Also ListedDentistTaxonomy 122300000X · License 019-022339 (IL), 019022339 (IL)

150 E HURON ST, Chicago, IL 60611

Open in Google Maps ↗

Other Identifiers 8

Other1760882005IL · Practice Location Type Ii Npi

Other019-022339IL · Dental-il

Other1063649770IL · Group Type Ii Npi

Other1205145554IL · Practice Location Type Ii Npi

Other1295165439IL · Practice Location Type Ii Npi

Other1053431981IL · Group Type Ii Npi

Other1306177241IL · Practice Location Type Ii Npi

Other1508198474IL · Practice Location Type Ii Npi

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kevin R Wallace Dmd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1951691237

PECOS Enrollment IDI20160620000860

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.

Medicare Billing Reassignment

Medicare enrollment records show Kevin Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Dental Sleep Center Richard A Craig DDS Ltd

Same address

Dental

150 E HURON ST, SUITE 1103
Chicago, IL 60611

Reassigned Medicare billing, Illinois enrollment
8 clinicians in this Medicare group

NPI 1508198474 (312) 676-9893

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 8

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.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

313 services279 patients

Imaging of jaws and skull 70350

Imaging of jaws and skull involves taking detailed pictures of these areas to help diagnose and treat various conditions. This can include X-rays, CT scans, or MRI scans. These images allow doctors to view the bone structure, tissues, and any abnormalities present. It's a safe and painless process.

238 services238 patients

Ct scan of face without contrast 70486

A CT scan of the face without contrast is a non-invasive imaging procedure. It uses X-rays to create detailed pictures of your face, including bones, soft tissues, and blood vessels. It's often used to diagnose diseases, injuries, or abnormalities. No contrast dye is used in this procedure.

238 services238 patients

X-ray of lower jaws, upper jaws and teeth 70355

An X-ray of lower jaws, upper jaws, and teeth is a diagnostic procedure that uses radiation to create images of these areas. This helps in identifying issues like tooth decay, gum problems, or jawbone irregularities. It's a quick, painless process and crucial for maintaining oral health.

234 services234 patients

New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more 99202

This service involves an initial visit to the doctor's office or other outpatient setting. It typically lasts between 15-29 minutes. The doctor will review your medical history, conduct a physical examination, and discuss your health concerns. It's a chance to establish your health baseline and address any immediate medical issues.

119 services119 patients

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.

113 services113 patients

Hospital Affiliations CMS Care Compare 5

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

Northwestern Lake Forest Hospital

Acute Care Hospitals · Lake Forest, IL

5/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number140130

Location1000 N Westmoreland RoadLake Forest, IL 60045 · Lake County

Emergency services Birthing friendly

Northwestern Medicine Delnor Community Hospital

Acute Care Hospitals · Geneva, IL

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number140211

Location300 Randall RdGeneva, IL 60134 · Kane County

Emergency services Birthing friendly

Advocate Lutheran General Hospital

Acute Care Hospitals · Park Ridge, IL

5/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number140223

Location1775 Dempster StPark Ridge, IL 60068 · Cook County

Emergency services Birthing friendly

Northwestern Memorial Hospital

Acute Care Hospitals · Chicago, IL

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number140281

Location251 E Huron StChicago, IL 60611 · Cook County

Emergency services Birthing friendly

Advocate Good Shepherd Hospital

Acute Care Hospitals · Barrington, IL

4/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number140291

Location450 West Highway 22Barrington, IL 60010 · Lake County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60611 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

$94.06 typical visit price

range $60.08 – $183.39

Typical copayment $23.51 (range $15.02 – $45.84)

Most-billed visit code 99203

Established Patient

$74.80 typical visit price

range $18.97 – $148.12

Typical copayment $18.70 (range $4.74 – $37.03)

Most-billed visit code 99213

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.

WENDY R MURRAY R.N., L.AC

Acupuncturist

150 E HURON ST, SUITE 1100
CHICAGO, IL 60611

Cook County (312) 926-6146

CHARLES LOCKHART DDS

Dentist (General Practice)

150 E HURON ST, SUITE 1103
CHICAGO, IL 60611

Cook County (312) 676-9893

PAYTON CHALMERS

Counselor (Professional)

150 E HURON ST
CHICAGO, IL 60611

Cook County (312) 549-8818

ZIBUTE G ZAPARACKAS MD AND PAUL A KNEPPER MD LTD

Ophthalmology

150 E HURON ST, SUITE 1000
CHICAGO, IL 60611

Cook County (312) 337-1285

RENEE GENOVA LMT

Massage Therapist

150 E HURON ST, SUITE 1100
CHICAGO, IL 60611

Cook County (312) 926-3627

FEELY LTD

Family Medicine

150 E HURON ST, SUITE 1104
CHICAGO, IL 60611

Cook County (312) 266-8565

ANNE S LEAVELL

Dietitian, Registered

150 E HURON ST, SUITE 1100
CHICAGO, IL 60611

Cook County (312) 926-9355

JOSEPH MATTHEW AYRES LSW

Social Worker

150 E HURON ST
CHICAGO, IL 60611

Cook County (312) 847-5312

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 Kevin Wallace's NPI number?

The NPI number for Kevin Wallace is 1053423285. It was assigned to this individual provider in the NPPES registry on September 1, 2006.

Where is Kevin Wallace located?

Kevin Wallace practices at 150 E Huron St Ste 1103, Chicago, IL 60611. The listed phone number is (312) 676-9893.

What is Kevin Wallace's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Kevin Wallace enrolled in Medicare?

Yes. Kevin Wallace is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kevin Wallace's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kevin Wallace reassigns Medicare benefits to Dental Sleep Center Richard A Craig DDS Ltd (Chicago, IL). The 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 Kevin Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kevin Wallace accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas list Kevin Wallace as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Kevin Wallace affiliated with any hospitals?

According to CMS data, Kevin Wallace is affiliated with Northwestern Lake Forest Hospital, Northwestern Medicine Delnor Community Hospital, Advocate Lutheran General Hospital, Northwestern Memorial Hospital and Advocate Good Shepherd Hospital.

When was this NPI record last updated?

The NPPES record for Kevin Wallace was last updated on January 19, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.