WALLACE CLEMENTS TARRY MD
NPI 1205804945
Surgery - Vascular Surgery in Mooresville, NC
About Wallace Clements Tarry Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WALLACE CLEMENTS TARRY MD (NPI 1205804945) is an individual vascular surgery provider in Mooresville, North Carolina, licensed in North Carolina (200200613) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS, is affiliated with Atrium Health Navicent The Medical Center, and maintains 4 additional practice locations.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Locations 4
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
Wallace Clements Tarry Md 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
2Medicare enrollment records show Wallace Tarry reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Mooresville, NC 28117
- Reassigned Medicare billing, North Carolina enrollment
- 1,646 clinicians in this Medicare group
Macon, GA 31201
- Reassigned Medicare billing, Georgia enrollment
- 483 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 11
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 4
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Atrium Health Navicent The Medical Center
Acute Care Hospitals · Macon, GACarolinas Medical Center-Northeast
Acute Care Hospitals · Concord, NCLake Norman Regional Medical Center
Acute Care Hospitals · Mooresville, NCAtrium Health University City
Acute Care Hospitals · Charlotte, NCPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 28117 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 7
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
MOORESVILLE, NC 28117
MOORESVILLE, NC 28117
MOORESVILLE, NC 28117
MOORESVILLE, NC 28117
MOORESVILLE, NC 28117
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 Wallace Tarry's NPI number?
The NPI number for Wallace Tarry is 1205804945. It was assigned to this individual provider in the NPPES registry on March 9, 2006.
Where is Wallace Tarry located?
Wallace Tarry practices at 146 Medical Park Rd Ste 206, Mooresville, NC 28117. The listed phone number is (704) 799-3939.
What is Wallace Tarry's specialty?
The primary specialty registered for this NPI is Surgery, specializing in Vascular Surgery, with taxonomy code 2086S0129X.
Is Wallace Tarry enrolled in Medicare?
Yes. Wallace Tarry 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 Wallace Tarry's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Wallace Tarry reassigns Medicare benefits to 2 organizations: Carolinas Physicians Network Inc (Mooresville, NC) and Health Services Of Central Georgia, Inc (Macon, GA). 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 Wallace Tarry's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Wallace Tarry accept?
Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and Blue Cross and Blue Shield of NC and 1 other insurer list Wallace Tarry 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 Wallace Tarry affiliated with any hospitals?
According to CMS data, Wallace Tarry is affiliated with Atrium Health Navicent The Medical Center, Carolinas Medical Center-Northeast, Lake Norman Regional Medical Center and Atrium Health University City.
When was this NPI record last updated?
The NPPES record for Wallace Tarry was last updated on July 16, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Wallace Clements Tarry, MD · NPI 1205804945
Vascular Surgery physician in Mooresville, North Carolina. Individual provider, active in the CMS NPPES registry since March 9, 2006.
## Identity
- **NPI:** 1205804945 (Entity type: Individual)
- **Enumerated:** March 9, 2006
- **Primary specialty:** Surgery - Vascular Surgery · taxonomy 2086S0129X
- **State license:** 200200613 (North Carolina)
- **Sole proprietor:** No
## Practice location
- **Address:** 146 MEDICAL PARK RD, STE 206, Mooresville, NC 28117-8528
- **Phone:** (704) 799-3939
## 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:** 2 organizations under Medicare reassignment (form CMS-855R): Carolinas Physicians Network Inc (NPI 1619464559, Mooresville, NC); Health Services Of Central Georgia, Inc (NPI 1184679482, Macon, GA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Duke University School Of Medicine, class of 1989
## Record status
- **NPPES last updated:** July 16, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1205804945) · Data from the CMS NPPES public registry.