1. Home
  2. Directory
  3. New Jersey
  4. Nutley
  5. Otolaryngology
  6. NPI Profile

DERRICK I WALLACE M.D.
NPI 1114900362
Otolaryngology in Nutley, NJ

Active since November 22, 2005PECOS EnrolledAccepts Medicare Assignment
187 WASHINGTON AVE, SUITE 2I, NUTLEY, NJ 07110(973) 235-0090(973) 235-0090 Get Directions Write a Review

NPPES record last updated: November 29, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Derrick I Wallace M.d. NPPES

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

DERRICK I WALLACE M.D. (NPI 1114900362) is an individual otolaryngology provider in Nutley, New Jersey, licensed in New Jersey (25MA08175200) and active in the NPI registry since November 2005. He is enrolled in Medicare PECOS, is affiliated with Overlook Medical Center, and is a graduate of Icahn School Of Medicine At Mount Sinai (1996).

NPPES Registry Identity

NPI1114900362
Entity TypeIndividualMale
Primary Taxonomy207Y00000X
Provider Legal NameDERRICK I WALLACECredential: M.D.
Location Address187 WASHINGTON AVE, SUITE 2INutley, NJ 07110-3935
Mailing Address187 Washinton Ave, Suite 2iNutley, NJ 07110-1980 · (973) 235-0090 · Fax (973) 842-0830
Phone(973) 235-0090
Fax(973) 235-0090
Sole ProprietorYes
Medical School CMSIcahn School Of Medicine At Mount SinaiGraduated 1996
Enumeration DateNovember 22, 2005
Last NPPES UpdateNovember 29, 2011
✔ NPI 1114900362 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOtolaryngologyAllopathic & Osteopathic Physicians
Taxonomy Code207Y00000X
Licenses✔ Licensed in NJ · 25MA08175200✔ Licensed in NY · 208988
Definition
An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.
187 WASHINGTON AVE, Nutley, NJ 07110
Open in Google Maps ↗

Other Identifiers 3

Medicaid02237176NY
Medicare UPINH62271NY
Medicare ID-Type Unspecified7M8681NY

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

Derrick I Wallace M.d. 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 ID4082657507
PECOS Enrollment IDI20070720000242
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 8

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.
280 services228 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.
197 services197 patients
Removal of impacted ear wax 69210
Impacted ear wax removal is a safe procedure to clear blockages in the ear canal caused by hardened ear wax. A healthcare professional uses specialized tools or a gentle irrigation method to loosen and remove the wax, improving hearing and alleviating discomfort.
177 services154 patients
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.
90 services77 patients
Diagnostic exam of nasal passages using an endoscope 31231
A diagnostic exam of nasal passages using an endoscope is a non-invasive procedure. A small, flexible tube with a light and camera at the end, called an endoscope, is inserted into the nose. This allows the doctor to view the nasal passages and sinuses, helping to identify any issues.
69 services62 patients
Diagnostic exam of voice box using a flexible endoscope 31575
This procedure involves a doctor examining your voice box using a flexible endoscope, a thin tube with a light and camera. It's inserted through your nose or mouth to visualize your throat area. It helps detect any abnormalities in your voice box, ensuring optimal vocal health.
38 services37 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Overlook Medical Center

Acute Care Hospitals · Summit, NJ
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number310051
Location99 Beauvoir AvenueSummit, NJ 07901 · Union County
Emergency services Birthing friendly

Hackensack Meridian Health, Mountainside Medical

Acute Care Hospitals · Montclair, NJ
2/5 CMS rating
OwnershipProprietary
CMS Certification Number310054
Location1 Bay AvenueMontclair, NJ 07042 · Essex County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 07110 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
$144.86 typical visit price
range $63.84 – $190.92
Typical copayment $36.21 (range $15.96 – $47.73)
Most-billed visit code 99204
Established Patient
$79.09 typical visit price
range $20.97 – $155.92
Typical copayment $19.77 (range $5.24 – $38.98)
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 4

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

EAR NOSE AND THROAT SOLUTIONS OF NJ
Otolaryngology
187 WASHINGTON AVE, SUITE 2I
NUTLEY, NJ 07110
Essex County (973) 235-0090
VANESSA MATOS LPC
Counselor (Professional)
187 WASHINGTON AVE, SUITE 2C
NUTLEY, NJ 07110
Essex County (862) 201-9127
DR. MICHELE ROBYN SEGAL M.D.
Pediatrics (Adolescent Medicine)
187 WASHINGTON AVE, SUITE 2D
NUTLEY, NJ 07110
Essex County (973) 235-9449
DR. JOSE A PAGAN D.M.D.
Dentist (General Practice)
187 WASHINGTON AVE
NUTLEY, NJ 07110
Essex County (973) 661-2929

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 Derrick Wallace's NPI number?

The NPI number for Derrick Wallace is 1114900362. It was assigned to this individual provider in the NPPES registry on November 22, 2005.

Where is Derrick Wallace located?

Derrick Wallace practices at 187 Washington Ave Suite 2I, Nutley, NJ 07110. The listed phone number is (973) 235-0090.

What is Derrick Wallace's specialty?

The primary specialty registered for this NPI is Otolaryngology with taxonomy code 207Y00000X.

Is Derrick Wallace enrolled in Medicare?

Yes. Derrick 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.

Is Derrick Wallace affiliated with any hospitals?

According to CMS data, Derrick Wallace is affiliated with Overlook Medical Center and Hackensack Meridian Health, Mountainside Medical.

When was this NPI record last updated?

The NPPES record for Derrick Wallace was last updated on November 29, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.