AUNDREA LEIGHANN WALLACE
NPI 1053930404
Nurse Practitioner - Family in Knoxville, TN

Q: What is Aundrea Wallace's NPI number?

The NPI number for Aundrea Wallace is 1053930404. It was assigned to this individual provider in the NPPES registry on April 15, 2020.

Q: What is Aundrea Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Aundrea Wallace was last updated on November 15, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months 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 15, 2020PECOS EnrolledAccepts Medicare Assignment

103 MIDLAKE DR UPPR LEVEL, KNOXVILLE, TN 37918(865) 687-1973(833) 908-2091 Get Directions Write a Review

NPPES record last updated: November 15, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 15, 2024, Apr 15, 2020 (2 updates tracked since 2020).

On this page

About Aundrea Leighann Wallace NPPES

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

AUNDREA LEIGHANN WALLACE (NPI 1053930404) is an individual family provider in Knoxville, Tennessee, licensed in Tennessee (27443) and active in the NPI registry since April 2020. She is enrolled in Medicare PECOS and is a graduate of East Tennessee State University Quillen College Of Medicine (2019).

NPPES Registry Identity

NPI1053930404

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameAUNDREA LEIGHANN WALLACE

Location Address103 MIDLAKE DR UPPR LEVELKnoxville, TN 37918-3002

Mailing Address1275 Dick Lonas RdKnoxville, TN 37909-1382 · (865) 584-4747 · Fax (865) 381-1509

Phone(865) 687-1973

Fax(833) 908-2091

Sole ProprietorNo

Medical School CMSEast Tennessee State University Quillen College Of MedicineGraduated 2019

Enumeration DateApril 15, 2020

Last NPPES UpdateNovember 15, 20242 updates tracked since enumeration

NPPES CertifiedNovember 15, 2024

✔ NPI 1053930404 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in TN · 27443

103 MIDLAKE DR UPPR LEVEL, Knoxville, TN 37918

Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BlueCross BlueShield of Tennessee, UnitedHealthcare.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

Aundrea Leighann Wallace 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 ID7911328463

PECOS Enrollment IDI20200609001165

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37918 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

$81.53 typical visit price

range $52.64 – $160.89

Typical copayment $20.38 (range $13.16 – $40.22)

Most-billed visit code 99203

Established Patient

$93.60 typical visit price

range $16.72 – $131.41

Typical copayment $23.40 (range $4.18 – $32.85)

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.

Referred Medical Equipment & Supplies CMS DME claims 9

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress E0260

DME-Hospital Beds · category DB000N

1 supplier28 claims28 services$73.06 avg. paid by Medicare

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

1 supplier16 claims16 services$20.03 avg. paid by Medicare

Patient lift, electric with seat or sling E0635

DME-Other DME · category DE000N

1 supplier11 claims11 services$91.01 avg. paid by Medicare

Manual wheelchair accessory, wheel lock brake extension (handle), each E0961

DME-Wheelchairs · category DD021N

2 suppliers16 claims32 services$2.08 avg. paid by Medicare

Manual wheelchair accessory, headrest extension, each E0966

DME-Wheelchairs · category DD021N

1 supplier11 claims11 services$5.98 avg. paid by Medicare

Manual wheelchair accessory, anti-tipping device, each E0971

DME-Wheelchairs · category DD021N

2 suppliers11 claims22 services$3.45 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 12

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

ALLISON PRYTULA PA-C

Physician Assistant