LYDIA WALLACE
NPI 1417344581
Emergency Medicine in Brockton, MA

Q: What is Lydia Wallace's NPI number?

The NPI number for Lydia Wallace is 1417344581. It was assigned to this individual provider in the NPPES registry on April 16, 2015.

Q: What is Lydia Wallace's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Q: When was this NPI record last updated?

The NPPES record for Lydia Wallace was last updated on August 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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 April 16, 2015PECOS EnrolledAccepts Medicare Assignment

235 N PEARL ST, BROCKTON, MA 02301(617) 414-5405 Get Directions Write a Review

NPPES record last updated: August 2, 2025. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: May 6, 2020, Oct 18, 2019 (2 updates tracked since 2019).

On this page

About Lydia Wallace NPPES

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

LYDIA WALLACE (NPI 1417344581) is an individual emergency medicine provider in Brockton, Massachusetts, licensed in Massachusetts (1024211) and active in the NPI registry since April 2015. She is enrolled in Medicare PECOS, is affiliated with Good Samaritan Medical Center, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1417344581

Entity TypeIndividualFemale

Primary Taxonomy207P00000X

Provider Legal NameLYDIA WALLACE

Location Address235 N PEARL STBrockton, MA 02301-1794

Mailing Address960 Massachusetts Ave Ste 2Boston, MA 02118-2690 · (617) 414-5405

Phone(617) 414-5405

Sole ProprietorYes

Medical School CMSTufts University School Of MedicineGraduated 2015

Enumeration DateApril 16, 2015

Last NPPES UpdateAugust 2, 20252 updates tracked since enumeration

NPPES CertifiedAugust 2, 2025

✔ NPI 1417344581 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207P00000X

Licenses✔ Licensed in MA · 1024211✔ Licensed in NM · MD2019-0840

Definition

An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.

235 N PEARL ST, Brockton, MA 02301

Open in Google Maps ↗

Secondary Practice Locations 2

Location 1145 Harrison Ave, Sackler Center 4th floorBoston, MA 02111-1802 · Phone (161) 763-6656

Location 2101 Hospital Loop NEAlbuquerque, NM 87109-2129 · Phone (615) 928-6268

Other Identifiers 1

OtherMD2019-08NM · License

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Lydia 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 ID4688989742

PECOS Enrollment IDI20191022000938, I20250826000801

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.

Areas of Expertise CMS Part B claims 3

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.

Emergency department visit with high level of medical decision making 99285

An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.

136 services132 patients

Emergency department visit with moderate level of medical decision making 99284

An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.

78 services74 patients

Emergency department visit with low level of medical decision making 99283

An emergency department visit for a problem of moderate severity involves immediate medical attention for issues like minor fractures, burns, or high fever. The healthcare team will assess your condition, provide necessary treatment, and may suggest further tests or admission if required.

12 services12 patients

Hospital Affiliations CMS Care Compare 2

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

Good Samaritan Medical Center

Acute Care Hospitals · Brockton, MA

2/5 CMS rating

OwnershipProprietary

CMS Certification Number220111

Location235 North Pearl StreetBrockton, MA 02301 · Plymouth County

Emergency services Birthing friendly

Lovelace Women's Hospital

Acute Care Hospitals · Albuquerque, NM

1/5 CMS rating

OwnershipProprietary

CMS Certification Number320017

Location4701 Montgomery Boulevard NEAlbuquerque, NM 87109 · Bernalillo County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 02301 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

$90.70 typical visit price

range $58.86 – $177.36

Typical copayment $22.67 (range $14.71 – $44.34)

Most-billed visit code 99203

Established Patient

$103.48 typical visit price

range $19.11 – $144.84

Typical copayment $25.87 (range $4.77 – $36.21)

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

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

Standard wheelchair K0001

DME-Wheelchairs · category DD000N

1 supplier11 claims11 services$15.53 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.

SAMANTHA A SIEGEL

Emergency Medicine