LODICA WALLACE
NPI 1114587557
Nurse Practitioner - Family in Commerce Twp, MI
About Lodica Wallace NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LODICA WALLACE (NPI 1114587557) is an individual family provider in Commerce Twp, Michigan, licensed in Michigan (2018023394) and active in the NPI registry since June 2019. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Lodica Wallace is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Lodica Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Southfield, MI 48075
- Reassigned Medicare billing, Michigan enrollment
- 393 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 48390 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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 Lodica Wallace's NPI number?
The NPI number for Lodica Wallace is 1114587557. It was assigned to this individual provider in the NPPES registry on June 18, 2019.
Where is Lodica Wallace located?
Lodica Wallace practices at 790 Drakeshire Dr, Commerce Twp, MI 48390. The listed phone number is (248) 910-2762.
What is Lodica Wallace's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Lodica Wallace enrolled in Medicare?
Yes. Lodica Wallace is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Lodica Wallace's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Lodica Wallace reassigns Medicare benefits to Henry Ford Health Providence Hospital (Southfield, MI). The 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 Lodica Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Lodica Wallace accept?
Health plans from Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, CareSource, CareSource (Common Ground Healthcare) and Priority Health list Lodica 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 Lodica Wallace was last updated on June 18, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Lodica Wallace · NPI 1114587557
Family physician in Commerce Twp, Michigan. Individual provider, active in the CMS NPPES registry since June 18, 2019.
## Identity
- **NPI:** 1114587557 (Entity type: Individual)
- **Enumerated:** June 18, 2019
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 2018023394 (Michigan)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 790 DRAKESHIRE DR, Commerce Twp, MI 48390-2981
- **Phone:** (248) 910-2762
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Henry Ford Health Providence Hospital (NPI 1003871062, Southfield, MI), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 18, 2019
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Source: [NPI Profile](https://npiprofile.com/npi/1114587557) · Data from the CMS NPPES public registry.