BLAKE TAYLOR WALLACE DPM
NPI 1083216949
Podiatrist - Foot & Ankle Surgery in Phoenix, AZ
About Blake Taylor Wallace Dpm NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BLAKE TAYLOR WALLACE DPM (NPI 1083216949) is an individual foot & ankle surgery provider in Phoenix, Arizona, licensed in Arizona (POD-001117) and active in the NPI registry since November 2020. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of California School Of Podiatric Medicine (2021).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Locations 2
Accepted Insurance
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
Blake Taylor Wallace Dpm 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 Blake Wallace reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Mesa, AZ 85202
- Reassigned Medicare billing, Arizona enrollment
- 8 clinicians in this Medicare group
Mesa, AZ 85202
- Reassigned Medicare billing, Arizona enrollment
- 7 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.
Other Providers at the Same Location NPPES
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 Blake Wallace's NPI number?
The NPI number for Blake Wallace is 1083216949. It was assigned to this individual provider in the NPPES registry on November 14, 2020.
Where is Blake Wallace located?
Blake Wallace practices at 15601 N 28th Ave Ste 102, Phoenix, AZ 85053. The listed phone number is (480) 844-8218.
What is Blake Wallace's specialty?
The primary specialty registered for this NPI is Podiatrist, specializing in Foot & Ankle Surgery, with taxonomy code 213ES0103X.
Is Blake Wallace enrolled in Medicare?
Yes. Blake 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 Blake Wallace's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Blake Wallace reassigns Medicare benefits to 2 organizations: Desert Foot & Ankle P C (Mesa, AZ) and Pnc Podiatry Of Arizona PC (Mesa, AZ). 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 Blake Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Blake Wallace accept?
Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Antidote Health Plan of Arizona, Inc., Blue Cross Blue Shield of Arizona and Cigna HealthCare of Arizona, Inc and 3 other insurers list Blake 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.
When was this NPI record last updated?
The NPPES record for Blake Wallace was last updated on July 29, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Blake Taylor Wallace, DPM · NPI 1083216949
Foot & Ankle Surgery provider in Phoenix, Arizona. Individual provider, active in the CMS NPPES registry since November 14, 2020.
## Identity
- **NPI:** 1083216949 (Entity type: Individual)
- **Enumerated:** November 14, 2020
- **Primary specialty:** Podiatrist - Foot & Ankle Surgery · taxonomy 213ES0103X
- **State license:** POD-001117 (Arizona)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 15601 N 28TH AVE STE 102, Phoenix, AZ 85053-4061
- **Phone:** (480) 844-8218
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Desert Foot & Ankle P C (NPI 1639398183, Mesa, AZ); Pnc Podiatry Of Arizona PC (NPI 1063168359, Mesa, AZ) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** California School Of Podiatric Medicine, class of 2021
## Record status
- **NPPES last updated:** July 29, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1083216949) · Data from the CMS NPPES public registry.