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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

LAURY M WALLACE NP
NPI 1205343845
Nurse Practitioner - Gerontology in Westfield, IN

Active since January 04, 2018PECOS Enrolled
16731 GAITHER BLVD, WESTFIELD, IN 46074(317) 561-6840(812) 239-3771 Get Directions Write a Review

NPPES record last updated: October 28, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Oct 28, 2026, Oct 6, 2026 (2 updates tracked since 2026).

About Laury M Wallace Np NPPES

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

LAURY M WALLACE NP (NPI 1205343845) is an individual gerontology provider in Westfield, Indiana, licensed in Montana (APRN-286647) and active in the NPI registry since January 2018. She is enrolled in Medicare PECOS and maintains a secondary practice location in Missoula.

NPPES Registry Identity

NPI1205343845
Entity TypeIndividualFemale
Primary Taxonomy363LG0600X
Provider Legal NameLAURY M WALLACECredential: NP
Location Address16731 GAITHER BLVDWestfield, IN 46074-4607
Mailing Address16731 Gaither BlvdWestfield, IN 46074-4421 · (812) 239-3771
Phone(317) 561-6840
Fax(812) 239-3771
Sole ProprietorYes
Enumeration DateJanuary 4, 2018
Last NPPES UpdateOctober 28, 20262 updates tracked since enumeration
NPPES CertifiedOctober 28, 2026
✔ NPI 1205343845 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyNurse Practitioner · GerontologyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LG0600X
License✔ Licensed in MT · APRN-286647
Also ListedFamily Medicine · Adolescent MedicineTaxonomy 207QA0000X · License 71007724A (IN)
Also ListedFamily Medicine · Adult MedicineTaxonomy 207QA0505X · License 71007724A (IN)
Also ListedFamily Medicine · Geriatric MedicineTaxonomy 207QG0300X · License 71007724A (IN)
Also ListedFamily Medicine · Hospice and Palliative MedicineTaxonomy 207QH0002X · License 71007724A (IN)
Also ListedNurse Practitioner · Primary CareTaxonomy 363LP2300X · License APRN-286647 (MT)
16731 GAITHER BLVD, Westfield, IN 46074
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Secondary Practice Location 1

Location 13760 Mullan RdMissoula, MT 59808-5123 · Phone (406) 551-2273 · Fax (406) 551-2073

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Laury M Wallace Np 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.

Medicare Billing Reassignment

Medicare enrollment records show Laury Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Lifes Journey Palliative Care
22 mi
Hospice and Palliative Medicine
10241 E COUNTY ROAD 100 N
Indianapolis, IN 46234
  • Reassigned Medicare billing, Indiana enrollment
  • 3 clinicians in this Medicare group
NPI 1497417828 (812) 239-3771

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46074 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
$82.04 typical visit price
range $53.07 – $161.76
Typical copayment $20.51 (range $13.26 – $40.44)
Most-billed visit code 99203
Established Patient
$94.22 typical visit price
range $16.93 – $132.22
Typical copayment $23.55 (range $4.23 – $33.05)
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.

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 Laury Wallace's NPI number?

The NPI number for Laury Wallace is 1205343845. It was assigned to this individual provider in the NPPES registry on January 4, 2018.

Where is Laury Wallace located?

Laury Wallace practices at 16731 Gaither Blvd, Westfield, IN 46074. The listed phone number is (317) 561-6840.

What is Laury Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

Is Laury Wallace enrolled in Medicare?

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

Which organization bills Medicare for Laury Wallace's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Laury Wallace reassigns Medicare benefits to Lifes Journey Palliative Care (Indianapolis, IN). The 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 Laury Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Laury Wallace was last updated on October 28, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 days 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.