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LIZABETH WALLACE
NPI 1417019084
Nurse Practitioner in Peoria, IL

Active since December 13, 2006PECOS EnrolledAccepts Medicare Assignment
420 NE GLEN OAK AVE, PEORIA, IL 61603(309) 655-2343(309) 655-3948 Get Directions Write a Review

NPPES record last updated: April 20, 2009. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Lizabeth Wallace NPPES

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

LIZABETH WALLACE (NPI 1417019084) is an individual nurse practitioner in Peoria, Illinois, licensed in Illinois (0411285741-209004409) and active in the NPI registry since December 2006. She is enrolled in Medicare PECOS and is a graduate of Other (2002).

NPPES Registry Identity

NPI1417019084
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameLIZABETH WALLACE
Location Address420 NE GLEN OAK AVEPeoria, IL 61603-3105
Mailing Address420 Ne Glen Oak AvePeoria, IL 61603-3105 · (309) 655-2343 · Fax (309) 655-3948
Phone(309) 655-2343
Fax(309) 655-3948
Sole ProprietorNo
Medical School CMSOtherGraduated 2002
Enumeration DateDecember 13, 2006
Last NPPES UpdateApril 20, 2009
✔ NPI 1417019084 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in IL · 0411285741-209004409
Definition
(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.
420 NE GLEN OAK AVE, Peoria, IL 61603
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Other Identifiers 4

Medicare UPINQ75702
Other207594001IL · Medicare Individual Id/k35369 Deactivated
Medicare ID-Type UnspecifiedK35369IL · Individual #
Medicare ID-Type Unspecified207594IL · Group #

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

Lizabeth Wallace 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.

PECOS PAC ID8123121480
PECOS Enrollment IDI20090504000561
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 Reassignment

Medicare enrollment records show Lizabeth Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Osf Multi-Specialty Group
7.4 mi
Internal Medicine
8600 N STATE ROUTE 91
Peoria, IL 61615
  • Reassigned Medicare billing, Illinois enrollment
  • 2,944 clinicians in this Medicare group
NPI 1922445527 (309) 683-5050

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61603 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
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$97.25 typical visit price
range $17.16 – $136.56
Typical copayment $24.31 (range $4.29 – $34.14)
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.

LINDA SCHMIDGALL
Nurse Practitioner
420 NE GLEN OAK AVE, SUITE 200
PEORIA, IL 61603
Peoria County (309) 624-5100
SANDRA L. PEACH APN
Nurse Practitioner
420 NE GLEN OAK AVE
PEORIA, IL 61603
Peoria County (309) 655-2343
SAINT FRANCIS MEDICAL CENTER
Pediatrics (Pediatric Cardiology)
420 NE GLEN OAK AVE, SUITE 304
PEORIA, IL 61603
Peoria County (309) 655-3453
CHARLES APRAHAMIAN MD
Surgery (Pediatric Surgery)
420 NE GLEN OAK AVE, SUITE 201
PEORIA, IL 61603
Peoria County (309) 655-3800
MRS. HEATHER A BOORE APN, CNS-BC
Clinical Nurse Specialist (Pediatrics)
420 NE GLEN OAK AVE, SUITE 401
PEORIA, IL 61603
Peoria County (309) 624-9844
DR. MATTHEW T BRAMLET MD
Pediatrics (Pediatric Cardiology)
420 NE GLEN OAK AVE, SUITE 301
PEORIA, IL 61603
Peoria County (309) 655-3453
GREGORY PUSZKIEWICZ R.PH.
Pharmacist
420 NE GLEN OAK AVE
PEORIA, IL 61603
Peoria County (309) 624-8777
PEDIATRIC CARDIOLOGY ASSOCIATES SC
Pediatrics (Pediatric Cardiology)
420 NE GLEN OAK AVE, SUITE 304
PEORIA, IL 61603
Peoria County (309) 655-3453

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 Lizabeth Wallace's NPI number?

The NPI number for Lizabeth Wallace is 1417019084. It was assigned to this individual provider in the NPPES registry on December 13, 2006.

Where is Lizabeth Wallace located?

Lizabeth Wallace practices at 420 NE Glen Oak Ave, Peoria, IL 61603. The listed phone number is (309) 655-2343.

What is Lizabeth Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Lizabeth Wallace enrolled in Medicare?

Yes. Lizabeth 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 Lizabeth Wallace's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Lizabeth Wallace reassigns Medicare benefits to Osf Multi-Specialty Group (Peoria, IL). 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 Lizabeth 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 Lizabeth Wallace was last updated on April 20, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.