MS. SARA ELIZABETH WALLACE-KEESHEN FNP-BC
NPI 1407540602
Nurse Practitioner - Primary Care in Philadelphia, PA

Q: What is Sara Wallace-keeshen's NPI number?

The NPI number for Sara Wallace-keeshen is 1407540602. It was assigned to this individual provider in the NPPES registry on June 8, 2023.

Q: What is Sara Wallace-keeshen's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Active since June 08, 2023PECOS Enrolled

2144 CECIL B MOORE AVE, PHILADELPHIA, PA 19121(215) 320-6187 Get Directions Write a Review

NPPES record last updated: June 8, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Ms. Sara Elizabeth Wallace-keeshen Fnp-bc NPPES

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

MS. SARA ELIZABETH WALLACE-KEESHEN FNP-BC (NPI 1407540602) is an individual primary care provider in Philadelphia, Pennsylvania, licensed in Pennsylvania (SP027631) and active in the NPI registry since June 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1407540602

Entity TypeIndividualFemale

Primary Taxonomy363LP2300X

Provider Legal NameMS. SARA ELIZABETH WALLACE-KEESHENCredential: FNP-BC

Location Address2144 CECIL B MOORE AVEPhiladelphia, PA 19121-4014

Mailing Address2650 Agate StPhiladelphia, PA 19125-2302 · (864) 275-4820

Phone(215) 320-6187

Sole ProprietorNo

Medical School CMSOtherGraduated 2022

Enumeration DateJune 8, 2023

NPPES CertifiedJune 8, 2023

✔ NPI 1407540602 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP2300X

License✔ Licensed in PA · SP027631

2144 CECIL B MOORE AVE, Philadelphia, PA 19121

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Sara Elizabeth Wallace-keeshen Fnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1355816109

PECOS Enrollment IDI20260408003982

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19121 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

$92.69 typical visit price

range $59.88 – $180.99

Typical copayment $23.17 (range $14.97 – $45.24)

Most-billed visit code 99203

Established Patient

$105.21 typical visit price

range $19.30 – $147.29

Typical copayment $26.30 (range $4.82 – $36.82)

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.

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.

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Nurse Practitioner (Psychiatric/Mental Health)