TIMOTHY R WALLACE D.O.
NPI 1275725384
Family Medicine in Oshkosh, WI

Q: What is Timothy Wallace's NPI number?

The NPI number for Timothy Wallace is 1275725384. It was assigned to this individual provider in the NPPES registry on August 13, 2007.

Q: What is Timothy Wallace's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Timothy Wallace was last updated on April 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months 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 August 13, 2007PECOS Enrolled

855 N WESTHAVEN DR, OSHKOSH, WI 54904(920) 303-8700(920) 303-8832 Get Directions Write a Review

NPPES record last updated: April 9, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Apr 9, 2025, Dec 6, 2021 (2 updates tracked since 2021).

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About Timothy R Wallace D.o. NPPES

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

TIMOTHY R WALLACE D.O. (NPI 1275725384) is an individual family medicine provider in Oshkosh, Wisconsin, licensed in Wisconsin (60032) and active in the NPI registry since August 2007. He is enrolled in Medicare PECOS, is affiliated with Aurora Medical Ctr Oshkosh, and is a graduate of Other (2004).

NPPES Registry Identity

NPI1275725384

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameTIMOTHY R WALLACECredential: D.O.

Location Address855 N WESTHAVEN DROshkosh, WI 54904-7668

Mailing AddressPo Box 735044Chicago, IL 60673-5044 · (800) 326-2250

Phone(920) 303-8700

Fax(920) 303-8832

Sole ProprietorNo

Medical School CMSOtherGraduated 2004

Enumeration DateAugust 13, 2007

Last NPPES UpdateApril 9, 20252 updates tracked since enumeration

NPPES CertifiedApril 9, 2025

✔ NPI 1275725384 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Licenses✔ Licensed in WI · 60032✔ Licensed in PA · OS013436✔ Licensed in SC · 1195

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

855 N WESTHAVEN DR, Oshkosh, WI 54904

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Other Identifiers 5

Medicaid100028993WI

Other1195SC · Medical License

OtherOS013436PA · License

Medicaid011953SC

Other60032-021WI · Medical License

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Aspirus Health Plan, CareSource (Common Ground Healthcare) and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Timothy R Wallace D.o. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID2466545637

PECOS Enrollment IDI20130613000405

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 Reassignments

Medicare enrollment records show Timothy Wallace reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Aurora Medical Group, Inc.

47 mi

Clinic/Center

2414 KOHLER MEMORIAL DR
Sheboygan, WI 53081

Reassigned Medicare billing, Wisconsin enrollment
4,609 clinicians in this Medicare group

NPI 1174670244 (920) 457-4461

Aamg Reach PLLC

167 mi

Family Medicine

1357 W 103RD ST
Chicago, IL 60643

Reassigned Medicare billing, Wisconsin enrollment
41 clinicians in this Medicare group

NPI 1609502707 (773) 238-0800

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 6

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.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

178 services112 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

127 services88 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

119 services119 patients

Administration of influenza virus vaccine G0008

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

52 services51 patients

Influenza vaccine split virus, preservative free 90662

The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.

41 services41 patients

Transitional care management services for problem of high complexity 99496

Transitional care management services are designed to ensure a smooth transition from a hospital to home or another care setting for patients with complex health issues. These services include medication management, patient education, and coordination with healthcare providers.

18 services12 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Aurora Medical Ctr Oshkosh

Acute Care Hospitals · Oshkosh, WI

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number520198

Location855 N Westhaven DriveOshkosh, WI 54904 · Winnebago County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54904 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

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$95.41 typical visit price

range $17.40 – $133.76

Typical copayment $23.85 (range $4.35 – $33.44)

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.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

4 suppliers21 claims46 services$5.17 avg. paid by Medicare

Lancets, per box of 100 A4259

DME-Medical/Surgical Supplies · category DA000N

3 suppliers11 claims17 services$1.00 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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.

JACQUELINE ANN OTS PENDING

Nurse Practitioner