MICHAEL T WALLACE ARNP
NPI 1194029777
Nurse Practitioner - Adult Health in Minnetonka, MN

Q: What is Michael Wallace's NPI number?

The NPI number for Michael Wallace is 1194029777. It was assigned to this individual provider in the NPPES registry on December 22, 2010.

Q: What is Michael Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Q: When was this NPI record last updated?

The NPPES record for Michael Wallace was last updated on March 7, 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.

Active since December 22, 2010PECOS Enrolled

9900 BREN RD E, MINNETONKA, MN 55343(352) 529-7314 Get Directions Write a Review

NPPES record last updated: March 7, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 7, 2023, Sep 9, 2020, Oct 14, 2016 (3 updates tracked since 2016).

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About Michael T Wallace Arnp NPPES

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

MICHAEL T WALLACE ARNP (NPI 1194029777) is an individual adult health provider in Minnetonka, Minnesota, licensed in Florida (ARNP2975042) and active in the NPI registry since December 2010. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1194029777

Entity TypeIndividualMale

Primary Taxonomy363LA2200X

Provider Legal NameMICHAEL T WALLACECredential: ARNP

Location Address9900 BREN RD EMinnetonka, MN 55343-9664

Mailing AddressPo Box 953Coleman, FL 33521-0953 · (352) 254-0153

Phone(352) 529-7314

Sole ProprietorNo

Enumeration DateDecember 22, 2010

Last NPPES UpdateMarch 7, 20233 updates tracked since enumeration

NPPES CertifiedSeptember 9, 2020

✔ NPI 1194029777 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LA2200X

Licenses✔ Licensed in FL · ARNP2975042✔ Licensed in WI · 7139-33

9900 BREN RD E, Minnetonka, MN 55343

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Other Identifiers 1

Medicaid007980600FL

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Michael T Wallace Arnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 55343 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

$85.82 typical visit price

range $56.00 – $168.28

Typical copayment $21.45 (range $14.00 – $42.07)

Most-billed visit code 99203

Established Patient

$98.61 typical visit price

range $18.32 – $138.04

Typical copayment $24.65 (range $4.58 – $34.51)

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.

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.

MAVIS OSEI YEBOAH NURSE PRACTITIONER

Nurse Practitioner