MR. CORY WALLACE MSN, AGPCNP-BC
NPI 1255066411
Nurse Practitioner in Somerset, NJ
NPI Status: Active since July 21, 2022
Contact Information
27 CLYDE RD STE 102
SOMERSET, NJ
ZIP 08873
Phone: (732) 246-0057
NPPES record last updated: March 9, 2026. Verified against the NPPES registry weekly; last sync: July 12, 2026.
Record update history: Mar 9, 2026, Jan 23, 2026, Jul 21, 2022 (3 updates tracked since 2022).
- Individual
- Male
- Years of Experience 2
- Nurse Practitioner
- May Accept Medicare Approved Payment
About CORY WALLACE
This page provides the complete NPI Profile along with additional information for Cory Wallace, a provider established in Somerset, New Jersey with a medical specialization in Nurse Practitioner and more than 2 years of experience. The healthcare provider is registered in the NPI registry with number 1255066411 assigned on July 2022. The practitioner's primary taxonomy code is 363L00000X with license number 26NJ15461200 (NJ). The provider is registered as an individual and his NPI record was last updated March 2026.
- NPI
- 1255066411
- Provider Name
- MR. CORY WALLACE MSN, AGPCNP-BC
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 27 CLYDE RD STE 102 SOMERSET, NJ 08873
- Location Phone
- (732) 246-0057
- Mailing Address
- 30 ULYSSES RD SOMERSET, NJ 08873
- Mailing Phone
- (973) 462-8797
- Medical School Name
- OTHER
- Graduation Year
- 2025
- Is Sole Proprietor?
- No
- Enumeration Date
- 07-21-2022
- Last Update Date
- 03-09-2026
- Code Navigator
A nurse practitioner (NP) like Cory Wallace is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nurse Practitioner
- Taxonomy Code
- 363L00000X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- 26NJ15461200
- License State
- NJ
- Taxonomy Description
- (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.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 163WG0000X | Nursing Service Providers | Registered Nurse | 26NR20435100 (NJ) |
Medicare Participation & PECOS Enrollment Status
Cory Wallace is registered with Medicare but may not accept claims assignment. If you are a Medicare beneficiary call and confirm with the provider before seeking any services.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
PECOS PAC ID: 4183192990
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20260508003635
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Maybe
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.
Reviews for MR. CORY WALLACE MSN, AGPCNP-BC
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NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1255066411, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 49. The final step is to find the difference between that total and the next multiple of ten (50 - 49 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 49 is 50. The difference is the calculated check digit.
Other Providers at the Same Location
The following 6 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1255066411, enumerated as an "individual" on July 21, 2022.
The provider is located at 27 CLYDE RD STE 102 SOMERSET, NJ 08873 and the phone number is (732) 246-0057.
Nurse Practitioner with taxonomy code 363L00000X.
