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CHARLESETTA WALLACE APRN, CNM
NPI 1114896032
Advanced Practice Midwife in Bloomington, IL

Active since October 30, 2025PECOS Enrolled
2111 E OAKLAND AVE STE B, BLOOMINGTON, IL 61701(309) 808-3068 Get Directions Write a Review

NPPES record last updated: October 30, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Charlesetta Wallace Aprn, Cnm NPPES

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

CHARLESETTA WALLACE APRN, CNM (NPI 1114896032) is an individual advanced practice midwife in Bloomington, Illinois, licensed in Illinois (209033647) and active in the NPI registry since October 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1114896032
Entity TypeIndividualFemale
Primary Taxonomy367A00000X
Provider Legal NameCHARLESETTA WALLACECredential: APRN, CNM
Location Address2111 E OAKLAND AVE STE BBloomington, IL 61701-5783
Mailing Address5100 W Bradford Woods Cir Apt TPeoria, IL 61615-8978 · (309) 357-0768
Phone(309) 808-3068
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateOctober 30, 2025
NPPES CertifiedOctober 30, 2025
✔ NPI 1114896032 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAdvanced Practice MidwifePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367A00000X
License✔ Licensed in IL · 209033647
Definition
Advanced practice midwifery encompasses the independent provision of care during pregnancy, childbirth, and the postpartum period; sexual and reproductive health; gynecologic health; and family planning services, including preconception care. Midwives also provide primary care for individuals from adolescence throughout the lifespan as well as care for the healthy newborn during the first 28 days of life. Midwives provide initial and ongoing comprehensive assessment, diagnosis, and treatment. Midwifery care includes health promotion, disease prevention, risk assessment and management, and individualized wellness education and counseling. Source: American College of Nurse-Midwives, www.midwife.org Additional Resources: See the American College of Nurse-Midwives, www.midwife.org, for more information on Certified Nurse-Midwives, Certified Midwives, the American Midwifery Certification Board (AMCB), and licensure.
2111 E OAKLAND AVE STE B, Bloomington, IL 61701
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Charlesetta Wallace Aprn, Cnm is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7517453541
PECOS Enrollment IDI20251230000662
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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61701 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
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$68.64 typical visit price
range $17.16 – $136.56
Typical copayment $17.16 (range $4.29 – $34.14)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAUREN HEIDENREICH
Advanced Practice Midwife
2111 E OAKLAND AVE STE B
BLOOMINGTON, IL 61701
McLean County (309) 808-3068
MICHAELA R KANE
Advanced Practice Midwife
2111 E OAKLAND AVE STE B
BLOOMINGTON, IL 61701
McLean County (309) 808-3068
BETHANY ANN BRADLEY CNM
Advanced Practice Midwife
2111 E OAKLAND AVE STE B
BLOOMINGTON, IL 61701
McLean County (309) 808-3068
MRS. LEIGH ANN KOWALSKI D.O.
Obstetrics & Gynecology
2111 E OAKLAND AVE STE B
BLOOMINGTON, IL 61701
McLean County (309) 808-3068
BRITTANY ZILLER APN
Nurse Practitioner
2111 E OAKLAND AVE STE B
BLOOMINGTON, IL 61701
McLean County (309) 808-3068
MRS. STEPHANIE RUTHERFORD PT
Physical Therapist
2111 E OAKLAND AVE STE B
BLOOMINGTON, IL 61701
McLean County (309) 808-3068

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 Charlesetta Wallace's NPI number?

The NPI number for Charlesetta Wallace is 1114896032. It was assigned to this individual provider in the NPPES registry on October 30, 2025.

Where is Charlesetta Wallace located?

Charlesetta Wallace practices at 2111 E Oakland Ave Ste B, Bloomington, IL 61701. The listed phone number is (309) 808-3068.

What is Charlesetta Wallace's specialty?

The primary specialty registered for this NPI is Advanced Practice Midwife with taxonomy code 367A00000X.

Is Charlesetta Wallace enrolled in Medicare?

Yes. Charlesetta Wallace is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Charlesetta Wallace was last updated on October 30, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months 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.