WALLACE FAMILY PRACTICE PA
NPI 1063548410
Clinic/Center in Lehigh Acres, FL
About Wallace Family Practice Pa NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WALLACE FAMILY PRACTICE PA (NPI 1063548410) is a healthcare organization registered as a clinic/center in Lehigh Acres, Florida and active in the NPI registry since February 2007. The organization holds a CLIA Waiver certificate valid through July 8, 2028 and lists Tasha B. Wallace, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 3
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Wallace Family Practice Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Wallace Family Practice PA, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 10D1060360
Wallace Family Practice, PA · Fort Myers, FLFrequently 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 Wallace Family Practice PA's NPI number?
The NPI number for Wallace Family Practice PA is 1063548410. It was assigned to this organization in the NPPES registry on February 27, 2007.
Where is Wallace Family Practice PA located?
Wallace Family Practice PA is located at 3400 Lee Blvd Suite 108, Lehigh Acres, FL 33971. The listed phone number is (239) 369-2903.
What is Wallace Family Practice PA's specialty?
The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.
Is Wallace Family Practice PA enrolled in Medicare?
Yes. Wallace Family Practice PA is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Wallace Family Practice PA?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Wallace Family Practice PA, in Family Practice and Nurse Practitioner. A 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 the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Wallace Family Practice PA hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 10D1060360) is associated with this NPI, valid through July 8, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Wallace Family Practice PA accept?
Health plans from AvMed list Wallace Family Practice PA 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.
When was this NPI record last updated?
The NPPES record for Wallace Family Practice PA was last updated on December 29, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.
# Wallace Family Practice Pa · NPI 1063548410
Clinic/Center organization in Lehigh Acres, Florida. Organization record, active in the CMS NPPES registry since February 27, 2007.
## Identity
- **NPI:** 1063548410 (Entity type: Organization)
- **Enumerated:** February 27, 2007
- **Primary specialty:** Clinic/Center · taxonomy 261Q00000X
- **Organization subpart:** No
- **Authorized official:** Tasha Wallace, PRESIDENT
## Practice location
- **Address:** 3400 LEE BLVD, SUITE 108, Lehigh Acres, FL 33971-1309
- **Phone:** (239) 369-2903 · **Fax:** (239) 369-0500
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (1), Nurse Practitioner (1); 1 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 29, 2010
- **Other identifiers:** Medicare PIN U1026Y (FL); Medicare UPIN H90975 (FL); Medicare UPIN AB224 (FL)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1063548410) · Data from the CMS NPPES public registry.