KELLEY ANNETTE WALLACE DO
NPI 1174753727
Hospitalist in Kernersville, NC
About Kelley Annette Wallace Do NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLEY ANNETTE WALLACE DO (NPI 1174753727) is an individual hospitalist provider in Kernersville, North Carolina, licensed in North Carolina (2012-00585) and active in the NPI registry since July 2009. She is enrolled in Medicare PECOS, is affiliated with Novant Health Forsyth Medical Center, and maintains a secondary practice location in High Point.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Kelley Annette Wallace Do 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.
Medicare Billing Reassignments
5Medicare enrollment records show Kelley Wallace reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Kernersville, NC 27284
- Reassigned Medicare billing, North Carolina enrollment
- 2,998 clinicians in this Medicare group
Kernersville, NC 27284
- Reassigned Medicare billing, North Carolina enrollment
- 1,202 clinicians in this Medicare group
Kernersville, NC 27284
- Reassigned Medicare billing, North Carolina enrollment
- 719 clinicians in this Medicare group
Kernersville, NC 27284
- Reassigned Medicare billing, North Carolina enrollment
- Medicare enrollment name: Wake Forest Health Network LLC
- 583 clinicians in this Medicare group
Mooresville, NC 28117
- Reassigned Medicare billing, North Carolina enrollment
- 926 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.
Areas of Expertise CMS Part B claims 4
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.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Novant Health Forsyth Medical Center
Acute Care Hospitals · Winston-Salem, NCPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 27284 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Referred Medical Equipment & Supplies CMS DME claims 3
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
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.
KERNERSVILLE, NC 27284
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 Kelley Wallace's NPI number?
The NPI number for Kelley Wallace is 1174753727. It was assigned to this individual provider in the NPPES registry on July 16, 2009.
Where is Kelley Wallace located?
Kelley Wallace practices at 1750 Kernersville Medical Pkwy, Kernersville, NC 27284. The listed phone number is (336) 564-4866.
What is Kelley Wallace's specialty?
The primary specialty registered for this NPI is Hospitalist with taxonomy code 208M00000X.
Is Kelley Wallace enrolled in Medicare?
Yes. Kelley 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.
Which organizations bill Medicare for Kelley Wallace's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelley Wallace reassigns Medicare benefits to 5 organizations: Novant Health Medical Group, LLC (Kernersville, NC), Forsyth Memorial Hospital Inc (Kernersville, NC), Novant Health Thomasville Medical Center, LLC (Kernersville, NC), Cornerstone Health Care PA (Kernersville, NC) and The Presbyterian Hospital (Mooresville, NC). Each 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 Kelley Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kelley Wallace accept?
Health plans from Cigna Healthcare list Kelley 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 Kelley Wallace affiliated with any hospitals?
According to CMS data, Kelley Wallace is affiliated with Novant Health Forsyth Medical Center.
When was this NPI record last updated?
The NPPES record for Kelley Wallace was last updated on May 23, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.
# Kelley Annette Wallace, DO · NPI 1174753727
Hospitalist physician in Kernersville, North Carolina. Individual provider, active in the CMS NPPES registry since July 16, 2009.
## Identity
- **NPI:** 1174753727 (Entity type: Individual)
- **Enumerated:** July 16, 2009
- **Primary specialty:** Hospitalist · taxonomy 208M00000X
- **State license:** 2012-00585 (North Carolina)
- **Sole proprietor:** No
## Practice location
- **Address:** 1750 KERNERSVILLE MEDICAL PKWY, Kernersville, NC 27284-7146
- **Phone:** (336) 564-4866 · **Fax:** (336) 277-6815
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 5 organizations under Medicare reassignment (form CMS-855R): Novant Health Medical Group, LLC (NPI 1033415377, Kernersville, NC); Forsyth Memorial Hospital Inc (NPI 1659724128, Kernersville, NC); Novant Health Thomasville Medical Center, LLC (NPI 1477399038, Kernersville, NC); Cornerstone Health Care PA (NPI 1780922831, Kernersville, NC); The Presbyterian Hospital (NPI 1477050698, Mooresville, NC) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2009
## Record status
- **NPPES last updated:** May 23, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1174753727) · Data from the CMS NPPES public registry.