WALLACE MEDICAL GROUP, INC
NPI 1104047596
Dermatology - Procedural Dermatology in Beverly Hills, CA
About Wallace Medical Group, Inc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WALLACE MEDICAL GROUP, INC (NPI 1104047596) is a healthcare organization registered as a procedural dermatology in Beverly Hills, California and active in the NPI registry since May 2007. The organization lists Paul Wesley Wallace, Medical Director, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 3
Group Practice 1
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 Medical Group, Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Wallace Medical Group, Inc, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Wallace Medical Group, Inc's NPI number?
The NPI number for Wallace Medical Group, Inc is 1104047596. It was assigned to this organization in the NPPES registry on May 1, 2007.
Where is Wallace Medical Group, Inc located?
Wallace Medical Group, Inc is located at 8920 Wilshire Blvd Suite 327, Beverly Hills, CA 90211. The listed phone number is (310) 652-8460.
What is Wallace Medical Group, Inc's specialty?
The primary specialty registered for this NPI is Dermatology, specializing in Procedural Dermatology, with taxonomy code 207NS0135X.
Is Wallace Medical Group, Inc enrolled in Medicare?
Yes. Wallace Medical Group, Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Wallace Medical Group, Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Wallace Medical Group, Inc. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Wallace Medical Group, Inc was last updated on October 16, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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 Medical Group, Inc · NPI 1104047596
Procedural Dermatology organization in Beverly Hills, California. Organization record, active in the CMS NPPES registry since May 1, 2007.
## Identity
- **NPI:** 1104047596 (Entity type: Organization)
- **Enumerated:** May 1, 2007
- **Primary specialty:** Dermatology - Procedural Dermatology · taxonomy 207NS0135X
- **Organization subpart:** No
- **Authorized official:** Paul Wallace, MEDICAL DIRECTOR
## Practice location
- **Address:** 8920 WILSHIRE BLVD, SUITE 327, Beverly Hills, CA 90211-2007
- **Phone:** (310) 652-8460
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Dermatology) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 16, 2007
- **Other identifiers:** Medicare ID-Type Unspecified W16377; Medicaid GR0062020 (CA); Medicare UPIN F46168
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Source: [NPI Profile](https://npiprofile.com/npi/1104047596) · Data from the CMS NPPES public registry.