MRS. NICHOLE WALLACE PA
NPI 1114379708
Physician Assistant - Medical in Brooklyn, NY

Active since July 06, 2016PECOS EnrolledAccepts Medicare Assignment
760 BROADWAY, BROOKLYN, NY 11206(718) 312-2312 Get Directions Write a Review

NPPES record last updated: August 18, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 18, 2023, Feb 13, 2020 (2 updates tracked since 2020).

About Mrs. Nichole Wallace Pa NPPES

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

MRS. NICHOLE WALLACE PA (NPI 1114379708) is an individual medical provider in Brooklyn, New York and active in the NPI registry since July 2016. She is enrolled in Medicare PECOS, maintains a secondary practice location in Ocoee, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1114379708
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameMRS. NICHOLE WALLACECredential: PA
Location Address760 BROADWAYBrooklyn, NY 11206-5317
Mailing Address833 Penfield StBronx, NY 10470-1322 · (718) 708-1913
Sole ProprietorNo
Medical School CMSOtherGraduated 2023
Enumeration DateJuly 6, 2016
Last NPPES UpdateAugust 18, 20232 updates tracked since enumeration
NPPES CertifiedAugust 18, 2023
NPI 1114379708 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
760 BROADWAY, Brooklyn, NY 11206

Secondary Practice Location 1

Location 110959 W Colonial Dr, Units 6&8Ocoee, FL 34761 · Phone (407) 554-4591

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

Mrs. Nichole Wallace Pa 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 ID941598932
PECOS Enrollment IDI20240415001291
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.

Areas of Expertise CMS Part B claims 4

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.
68 services66 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.
63 services63 patients
Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19) 87811
This is a test to detect COVID-19, the virus causing severe respiratory illness. It uses a method called immunoassay, which identifies the virus by its unique proteins. The test is directly observed for accuracy. It helps determine if you're currently infected.
41 services41 patients
Detection test by immunoassay with direct visual observation for influenza virus 87804
This is a test that identifies the influenza virus in your body. It works by using an immunoassay, a method that detects the presence of the virus through an immune response. The results are directly observable, making it a quick and efficient way to diagnose flu.
36 services35 patients

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.

Physician Assistant (Medical)
760 BROADWAY
BROOKLYN, NY 11206
Personal Emergency Response Attendant
760 BROADWAY
BROOKLYN, NY 11206
Nurse Practitioner (Family)
760 BROADWAY
BROOKLYN, NY 11206
Student in an Organized Health Care Education/Training Program
760 BROADWAY
BROOKLYN, NY 11206
Psychiatry & Neurology (Psychiatry)
760 BROADWAY, WOODHULL MEDICAL AND MENTAL HEALTH CENTER
BROOKLYN, NY 11206
Physician Assistant (Medical)
760 BROADWAY
BROOKLYN, NY 11206
Nurse Practitioner (Family)
760 BROADWAY
BROOKLYN, NY 11206
Dentist (Oral and Maxillofacial Surgery)
760 BROADWAY, ORAL SURGERY ROOM 2C320
BROOKLYN, NY 11206

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 Nichole Wallace's NPI number?

The NPI number for Nichole Wallace is 1114379708. It was assigned to this individual provider in the NPPES registry on July 6, 2016.

Where is Nichole Wallace located?

Nichole Wallace practices at 760 Broadway, Brooklyn, NY 11206. The listed phone number is (718) 312-2312.

What is Nichole Wallace's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Nichole Wallace enrolled in Medicare?

Yes. Nichole 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.

When was this NPI record last updated?

The NPPES record for Nichole Wallace was last updated on August 18, 2023. 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.