JESSICA A. WALLACE APRN, PMHNP
NPI 1114579364
Nurse Practitioner - Psychiatric/Mental Health in Janesville, WI

Q: What is Jessica Wallace's NPI number?

The NPI number for Jessica Wallace is 1114579364. It was assigned to this individual provider in the NPPES registry on July 9, 2019.

Q: What is Jessica Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Jessica Wallace was last updated on July 9, 2019. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since July 09, 2019PECOS EnrolledAccepts Medicare Assignment

903 MINERAL POINT AVE, JANESVILLE, WI 53548(608) 756-5555(608) 756-0174 Get Directions Write a Review

NPPES record last updated: July 9, 2019. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Jessica A. Wallace Aprn, Pmhnp NPPES

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

JESSICA A. WALLACE APRN, PMHNP (NPI 1114579364) is an individual psychiatric/mental health provider in Janesville, Wisconsin, licensed in Wisconsin (9344-33) and active in the NPI registry since July 2019. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2019).

NPPES Registry Identity

NPI1114579364

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameJESSICA A. WALLACECredential: APRN, PMHNP

Location Address903 MINERAL POINT AVEJanesville, WI 53548-2970

Mailing Address903 Mineral Point AveJanesville, WI 53548-2970 · (608) 756-5555 · Fax (608) 756-0174

Phone(608) 756-5555

Fax(608) 756-0174

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateJuly 9, 2019

✔ NPI 1114579364 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in WI · 9344-33

Also ListedRegistered Nurse · Psychiatric/Mental HealthTaxonomy 163WP0808X · License 179176-130 (WI)

903 MINERAL POINT AVE, Janesville, WI 53548

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Secondary Practice Locations 2

Location 12825 Prairie AveBeloit, WI 53511-1844 · Phone (608) 365-2709 · Fax (608) 368-3322

Location 21000 Mineral Point AveJanesville, WI 53548-2940 · Phone (608) 756-6508 · Fax (608) 741-6918

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, MercyCare Health Plans.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

Jessica A. Wallace Aprn, Pmhnp 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 ID5395071427

PECOS Enrollment IDI20190729000499

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 2

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 moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

216 services66 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

59 services19 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53548 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

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$95.41 typical visit price

range $17.40 – $133.76

Typical copayment $23.85 (range $4.35 – $33.44)

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.

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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.

KAMELA D. CISNEROS

Counselor (Professional)