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HOLLY A WALLACE APNP
NPI 1124660592
Nurse Practitioner in Summit, WI

Active since October 17, 2019PECOS EnrolledAccepts Medicare Assignment
36500 AURORA DR, SUMMIT, WI 53066(262) 434-1000(262) 434-5050 Get Directions Write a Review

NPPES record last updated: October 24, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Jul 27, 2022, Oct 17, 2019 (2 updates tracked since 2019).

About Holly A Wallace Apnp NPPES

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

HOLLY A WALLACE APNP (NPI 1124660592) is an individual nurse practitioner in Summit, Wisconsin, licensed in Wisconsin (9679) and active in the NPI registry since October 2019. She is enrolled in Medicare PECOS, is affiliated with Watertown Memorial Hospital, and maintains a secondary practice location in Waukesha.

NPPES Registry Identity

NPI1124660592
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameHOLLY A WALLACECredential: APNP
Location Address36500 AURORA DRSummit, WI 53066-4899
Mailing AddressPo Box 735044Chicago, IL 60673-5044 · (800) 326-2250
Phone(262) 434-1000
Fax(262) 434-5050
Sole ProprietorNo
Medical School CMSOtherGraduated 2019
Enumeration DateOctober 17, 2019
Last NPPES UpdateOctober 24, 20252 updates tracked since enumeration
NPPES CertifiedOctober 24, 2025
✔ NPI 1124660592 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in WI · 9679
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
36500 AURORA DR, Summit, WI 53066
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Secondary Practice Location 1

Location 12428 N Grandview Blvd Ste 102Waukesha, WI 53188-6906 · Phone (262) 875-5070 · Fax (866) 384-9486

Other Identifiers 1

Medicaid100094369WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Aspirus Health Plan, CareSource (Common Ground Healthcare) and more.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

Holly A Wallace Apnp 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 ID7214369735
PECOS Enrollment IDI20191121000030
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 5

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.
205 services148 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.
132 services90 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
21 services21 patients
Urinalysis, manual test 81002
A urinalysis is a simple, non-invasive test that checks the urine for various elements such as sugar, protein, and signs of infection. It can help detect many common conditions, including kidney disease and diabetes. The manual test involves a lab technician examining a urine sample.
13 services13 patients
Removal of impacted ear wax by washing 69209
Impacted ear wax removal by washing, also known as ear irrigation, involves using a pressurized flow of water to break up and dislodge the ear wax. This safe procedure helps restore normal hearing and relieve discomfort caused by the blockage.
11 services11 patients

Hospital Affiliations CMS Care Compare 2

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

Watertown Memorial Hospital

Acute Care Hospitals · Watertown, WI
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number520116
Location125 Hospital DriveWatertown, WI 53098 · Dodge County
Emergency services Birthing friendly

Aurora Medical Center - Summit

Acute Care Hospitals · Summit, WI
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number520206
Location36500 Aurora DriveSummit, WI 53066 · Waukesha County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53066 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.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) A4314
DME-Orthotic Devices · category DF000N
1 supplier11 claims11 services$22.26 avg. paid by Medicare
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each A4357
DME-Orthotic Devices · category DF000N
1 supplier11 claims11 services$8.57 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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.

BIJAN NEZAMI
Internal Medicine (Critical Care Medicine)
36500 AURORA DR
SUMMIT, WI 53066
Waukesha County (262) 434-1000
KEVIN L EGGLESTON M.D.
Hospitalist
36500 AURORA DR
SUMMIT, WI 53066
Waukesha County (262) 434-4711
KODY LEWIS PA C
Physician Assistant
36500 AURORA DR
SUMMIT, WI 53066
Waukesha County (262) 434-1000
REBECCA M STRIET M.D.
Preventive Medicine (Undersea and Hyperbaric Medicine)
36500 AURORA DR, DEPARTMENT OF WOUND CARE/HYPERBARIC MEDICINE 3RD FLOOR
SUMMIT, WI 53066
Waukesha County (262) 434-5000
REBECCA SUSA DPT, ATC-L
Physical Therapist
36500 AURORA DR
SUMMIT, WI 53066
Waukesha County (262) 434-2600
VIJAY JOHNSON M.D
Internal Medicine (Critical Care Medicine)
36500 AURORA DR
SUMMIT, WI 53066
Waukesha County (262) 434-1000
MRS. KELLY S CAMPBELL ANP-BC
Nurse Practitioner
36500 AURORA DR
SUMMIT, WI 53066
Waukesha County (262) 434-1000
DR. BRETT MCLACHLAN M.D.
Emergency Medicine
36500 AURORA DR
SUMMIT, WI 53066
Waukesha County (262) 434-1000

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 Holly Wallace's NPI number?

The NPI number for Holly Wallace is 1124660592. It was assigned to this individual provider in the NPPES registry on October 17, 2019.

Where is Holly Wallace located?

Holly Wallace practices at 36500 Aurora Dr, Summit, WI 53066. The listed phone number is (262) 434-1000.

What is Holly Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Holly Wallace enrolled in Medicare?

Yes. Holly 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.

What insurance does Holly Wallace accept?

Health plans from Anthem Blue Cross and Blue Shield, Aspirus Health Plan, CareSource (Common Ground Healthcare), Group Health Cooperative-SCW and HealthPartners and 5 other insurers list Holly 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.

Is Holly Wallace affiliated with any hospitals?

According to CMS data, Holly Wallace is affiliated with Watertown Memorial Hospital and Aurora Medical Center - Summit.

When was this NPI record last updated?

The NPPES record for Holly Wallace was last updated on October 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.