THERESA A WALLACE PA-C, ATC
NPI 1437404548
Physician Assistant in Daytona Beach, FL

Q: What is Theresa Wallace's NPI number?

The NPI number for Theresa Wallace is 1437404548. It was assigned to this individual provider in the NPPES registry on July 16, 2012.

Q: What is Theresa Wallace's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Theresa Wallace was last updated on November 21, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 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 July 16, 2012PECOS EnrolledAccepts Medicare Assignment

1865 LPGA BLVD, DAYTONA BEACH, FL 32117(386) 255-4596(386) 258-3561 Get Directions Write a Review

NPPES record last updated: November 21, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 21, 2024, Jul 6, 2022, Mar 30, 2020 and 2 more (5 updates tracked since 2019).

On this page

About Theresa A Wallace Pa-c, Atc NPPES

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

THERESA A WALLACE PA-C, ATC (NPI 1437404548) is an individual physician assistant in Daytona Beach, Florida, licensed in Florida (PA9113017) and active in the NPI registry since July 2012. She is enrolled in Medicare PECOS, is affiliated with Adventhealth New Smyrna Beach, and maintains 6 additional practice locations.

NPPES Registry Identity

NPI1437404548

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameTHERESA A WALLACECredential: PA-C, ATC

Location Address1865 LPGA BLVDDaytona Beach, FL 32117-7108

Mailing Address1865 Lpga BlvdDaytona Beach, FL 32117-7108 · (386) 255-4596 · Fax (386) 258-3561

Phone(386) 255-4596

Fax(386) 258-3561

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateJuly 16, 2012

Last NPPES UpdateNovember 21, 20245 updates tracked since enumeration

NPPES CertifiedNovember 21, 2024

✔ NPI 1437404548 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in FL · PA9113017

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Also ListedSpecialist/Technologist · Athletic TrainerTaxonomy 2255A2300X · License AL2836 (FL)

1865 LPGA BLVD, Daytona Beach, FL 32117

Open in Google Maps ↗

Secondary Practice Locations 6

Location 11165 Dunlawton Ave Ste 102Port Orange, FL 32127-2924 · Phone (386) 255-4596 · Fax (386) 258-3561

Location 21175 Dunlawton Ave Ste 1Port Orange, FL 32127-4741 · Phone (386) 255-4596 · Fax (386) 258-3561

Location 31075 Mason AveDaytona Beach, FL 32117-4611 · Phone (386) 255-4596 · Fax (386) 258-3561

Location 41890 Lpga Blvd Ste 240Daytona Beach, FL 32117-7131 · Phone (386) 255-4596 · Fax (386) 258-3561

Location 517 Old Kings Rd N Ste KPalm Coast, FL 32137-8283 · Phone (386) 255-4596 · Fax (386) 258-3561

Location 61325 San Marco Blvd, SUITE 102Jacksonville, FL 32207-8568 · Phone (904) 858-7045 · Fax (904) 858-7047

Other Identifiers 1

Medicaid105958900FL

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

Theresa A Wallace Pa-c, Atc 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 ID8426487091

PECOS Enrollment IDI20200402000254

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 6

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.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

247 services201 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

92 services89 patients

X-ray of lower and sacral spine, minimum of 4 views 72110

An X-ray of the lower and sacral spine involves capturing images of your lower back and tailbone area. It helps in identifying issues like fractures, arthritis, or other abnormalities. At least four different angles or 'views' are taken to get a comprehensive picture.

38 services38 patients

X-ray of pelvis, 1-2 views 72170

An X-ray of the pelvis, 1-2 views, is a quick and painless imaging test. It uses a small amount of radiation to produce images of the lower part of your torso. These images help to detect any abnormalities or injuries in your hip bones and surrounding structures.

28 services28 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

28 services28 patients

Testing for presence of drug, read by direct observation 80305

Testing for the presence of drugs involves collecting a sample, usually urine, which is then analyzed for specific substances. The process is monitored directly to ensure accuracy and integrity. This test helps to confirm if drugs are present in your system.

16 services16 patients

Hospital Affiliations CMS Care Compare 2

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

Adventhealth New Smyrna Beach

Acute Care Hospitals · New Smyrna Beach, FL

3/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number100014

Location401 Palmetto StNew Smyrna Beach, FL 32170 · Volusia County

Emergency services

Adventhealth Daytona Beach

Acute Care Hospitals · Daytona Beach, FL

5/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number100068

Location301 Memorial Medical ParkwayDaytona Beach, FL 32117 · Volusia County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32117 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

$87.62 typical visit price

range $56.00 – $171.84

Typical copayment $21.90 (range $14.00 – $42.96)

Most-billed visit code 99203

Established Patient

$70.04 typical visit price

range $17.57 – $139.16

Typical copayment $17.51 (range $4.39 – $34.79)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Leave this field empty

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.

BRENT WILKINS PA-C

Physician Assistant