MARY ELIZABETH WALLACE DNP, CRNP, A-GNP-C
NPI 1295503829
Nurse Practitioner - Adult Health in Oxon Hill, MD
About Mary Elizabeth Wallace Dnp, Crnp, A-gnp-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MARY ELIZABETH WALLACE DNP, CRNP, A-GNP-C (NPI 1295503829) is an individual adult health provider in Oxon Hill, Maryland, licensed in Maryland (R228560) and active in the NPI registry since December 2023. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mary Elizabeth Wallace Dnp, Crnp, A-gnp-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
3Medicare enrollment records show Mary Wallace reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Potomac, MD 20854
- Reassigned Medicare billing, Maryland enrollment
- 13 clinicians in this Medicare group
Potomac, MD 20854
- Reassigned Medicare billing, Maryland enrollment
- 16 clinicians in this Medicare group
Glen Burnie, MD 21061
- Reassigned Medicare billing, Maryland enrollment
- 5 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 8
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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 20745 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 6
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
OXON HILL, MD 20745
OXON HILL, MD 20745
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 Mary Wallace's NPI number?
The NPI number for Mary Wallace is 1295503829. It was assigned to this individual provider in the NPPES registry on December 13, 2023.
Where is Mary Wallace located?
Mary Wallace practices at 6178 Oxon Hill Rd, Oxon Hill, MD 20745. The listed phone number is (301) 292-9220.
What is Mary Wallace's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.
Is Mary Wallace enrolled in Medicare?
Yes. Mary Wallace is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Mary Wallace's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mary Wallace reassigns Medicare benefits to 3 organizations: Kinetic Medical Group (Potomac, MD), Kinetic Primary Care (Potomac, MD) and Bhawna Bahethi, MD LLC (Glen Burnie, MD). 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 Mary 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 Mary Wallace was last updated on December 13, 2023. 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.
# Mary Elizabeth Wallace, DNP, CRNP, A-GNP-C · NPI 1295503829
Adult Health physician in Oxon Hill, Maryland. Individual provider, active in the CMS NPPES registry since December 13, 2023.
## Identity
- **NPI:** 1295503829 (Entity type: Individual)
- **Enumerated:** December 13, 2023
- **Primary specialty:** Nurse Practitioner - Adult Health · taxonomy 363LA2200X
- **State license:** R228560 (Maryland)
- **Sole proprietor:** No
## Practice location
- **Address:** 6178 OXON HILL RD, Oxon Hill, MD 20745-3109
- **Phone:** (301) 292-9220
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): Kinetic Medical Group (NPI 1285228585, Potomac, MD); Kinetic Primary Care (NPI 1528761897, Potomac, MD); Bhawna Bahethi, MD LLC (NPI 1457685380, Glen Burnie, MD) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 13, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1295503829) · Data from the CMS NPPES public registry.