ANDREA NICOLE WALLACE FNP
NPI 1417455809
Nurse Practitioner - Family in Charlotte, NC
About Andrea Nicole Wallace Fnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ANDREA NICOLE WALLACE FNP (NPI 1417455809) is an individual family provider in Charlotte, North Carolina, licensed in North Carolina (5010264) and active in the NPI registry since January 2018. She is enrolled in Medicare PECOS, is affiliated with Carolinas Medical Center/behav Health, and maintains 4 additional practice locations.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Locations 4
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
Andrea Nicole Wallace Fnp 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 Reassignments
2Medicare enrollment records show Andrea Wallace reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Charlotte, NC 28277
- Reassigned Medicare billing, North Carolina enrollment
- 2,057 clinicians in this Medicare group
Charlotte, NC 28226
- Reassigned Medicare billing, North Carolina enrollment
- 157 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
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Carolinas Medical Center/Behav Health
Acute Care Hospitals · Charlotte, NCPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 28277 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
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.
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 Andrea Wallace's NPI number?
The NPI number for Andrea Wallace is 1417455809. It was assigned to this individual provider in the NPPES registry on January 31, 2018.
Where is Andrea Wallace located?
Andrea Wallace practices at 14214 Ballantyne Lake Rd Ste 100, Charlotte, NC 28277. The listed phone number is (704) 667-2650.
What is Andrea Wallace's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Andrea Wallace enrolled in Medicare?
Yes. Andrea 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 organizations bill Medicare for Andrea Wallace's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Andrea Wallace reassigns Medicare benefits to 2 organizations: Carolinas Physicians Network Inc (Charlotte, NC) and Arboretum Urgent Care Center (Charlotte, NC). 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 Andrea Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Andrea Wallace accept?
Health plans from Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee, Blue Cross and Blue Shield of NC and Oscar Health Plan of North Carolina, Inc and 1 other insurer list Andrea 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 Andrea Wallace affiliated with any hospitals?
According to CMS data, Andrea Wallace is affiliated with Carolinas Medical Center/Behav Health.
When was this NPI record last updated?
The NPPES record for Andrea Wallace was last updated on July 15, 2024. 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.
# Andrea Nicole Wallace, FNP · NPI 1417455809
Family physician in Charlotte, North Carolina. Individual provider, active in the CMS NPPES registry since January 31, 2018.
## Identity
- **NPI:** 1417455809 (Entity type: Individual)
- **Enumerated:** January 31, 2018
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 5010264 (North Carolina)
- **Sole proprietor:** No
## Practice location
- **Address:** 14214 BALLANTYNE LAKE RD, STE 100, Charlotte, NC 28277-3372
- **Phone:** (704) 667-2650
## 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:** 2 organizations under Medicare reassignment (form CMS-855R): Carolinas Physicians Network Inc (NPI 1437168937, Charlotte, NC); Arboretum Urgent Care Center (NPI 1457380313, Charlotte, NC) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2016
## Record status
- **NPPES last updated:** July 15, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1417455809) · Data from the CMS NPPES public registry.