MRS. PHYLLIS A WALLACE APRN
NPI 1366486417
Nurse Practitioner - Family in Konawa, OK
About Mrs. Phyllis A Wallace Aprn NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MRS. PHYLLIS A WALLACE APRN (NPI 1366486417) is an individual family provider in Konawa, Oklahoma, licensed in Oklahoma (35497) and active in the NPI registry since June 2006. She is enrolled in Medicare PECOS, is affiliated with Mercy Hospital Ada, and is a graduate of University Of Nebraska College Of Medicine (2002).
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 2
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
Mrs. Phyllis A Wallace Aprn 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 Reassignment
Medicare enrollment records show Phyllis Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Konawa, OK 74849
- Reassigned Medicare billing, Oklahoma enrollment
- 57 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 5
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 2
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Mercy Hospital Ada
Acute Care Hospitals · Ada, OKSsm Health St Anthony Hospital - Shawnee
Acute Care Hospitals · Shawnee, OKPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 74849 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
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.
KONAWA, OK 74849
KONAWA, OK 74849
KONAWA, OK 74849
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 Phyllis Wallace's NPI number?
The NPI number for Phyllis Wallace is 1366486417. It was assigned to this individual provider in the NPPES registry on June 16, 2006.
Where is Phyllis Wallace located?
Phyllis Wallace practices at 527 W 3rd St, Konawa, OK 74849. The listed phone number is (580) 925-3286.
What is Phyllis Wallace's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Phyllis Wallace enrolled in Medicare?
Yes. Phyllis Wallace 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 organization bills Medicare for Phyllis Wallace's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Phyllis Wallace reassigns Medicare benefits to Central Oklahoma Family Medical Center, Inc. (Konawa, OK). 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 Phyllis Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Phyllis Wallace accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 3 other insurers list Phyllis Wallace 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 Phyllis Wallace affiliated with any hospitals?
According to CMS data, Phyllis Wallace is affiliated with Mercy Hospital Ada and Ssm Health St Anthony Hospital - Shawnee.
When was this NPI record last updated?
The NPPES record for Phyllis Wallace was last updated on November 22, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Mrs. Phyllis A Wallace, APRN · NPI 1366486417
Family physician in Konawa, Oklahoma. Individual provider, active in the CMS NPPES registry since June 16, 2006.
## Identity
- **NPI:** 1366486417 (Entity type: Individual)
- **Enumerated:** June 16, 2006
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 35497 (Oklahoma)
- **Sole proprietor:** No
## Practice location
- **Address:** 527 W 3RD ST, Konawa, OK 74849-1415
- **Phone:** (580) 925-3286 · **Fax:** (580) 925-9149
## 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:** Central Oklahoma Family Medical Center, Inc. (NPI 1831291293, Konawa, OK), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of Nebraska College Of Medicine, class of 2002
## Record status
- **NPPES last updated:** November 22, 2021
- **Other identifiers:** Other 100155800B (OK); Medicaid 100155800A (OK)
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Source: [NPI Profile](https://npiprofile.com/npi/1366486417) · Data from the CMS NPPES public registry.