BRIAN WALLACE N.P.
NPI 1457561615
Nurse Practitioner - Primary Care in Tyler, TX
About Brian Wallace N.p. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BRIAN WALLACE N.P. (NPI 1457561615) is an individual primary care provider in Tyler, Texas, licensed in Colorado (RN 169685C) and active in the NPI registry since May 2007. He is enrolled in Medicare PECOS and is a graduate of Other (2007).
NPPES Registry Identity
Specialties & Licenses
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
Brian Wallace N.p. 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 Reassignment
Medicare enrollment records show Brian Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Aurora, CO 80016
- Reassigned Medicare billing, Colorado enrollment
- 1,270 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 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 75701 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 19
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 Brian Wallace's NPI number?
The NPI number for Brian Wallace is 1457561615. It was assigned to this individual provider in the NPPES registry on May 23, 2007.
Where is Brian Wallace located?
Brian Wallace practices at 1910 Roseland Blvd, Tyler, TX 75701. The listed phone number is (903) 533-0644.
What is Brian Wallace's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.
Is Brian Wallace enrolled in Medicare?
Yes. Brian 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 Brian Wallace's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Brian Wallace reassigns Medicare benefits to Intermountain Medical Group Denver, LLC (Aurora, CO). 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 Brian Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Brian Wallace accept?
Health plans from Select Health list Brian 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.
When was this NPI record last updated?
The NPPES record for Brian Wallace was last updated on March 12, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.
# Brian Wallace, N.P. · NPI 1457561615
Primary Care physician in Tyler, Texas. Individual provider, active in the CMS NPPES registry since May 23, 2007.
## Identity
- **NPI:** 1457561615 (Entity type: Individual)
- **Enumerated:** May 23, 2007
- **Primary specialty:** Nurse Practitioner - Primary Care · taxonomy 363LP2300X
- **State license:** RN 169685C (Colorado)
- **Sole proprietor:** No
## Practice location
- **Address:** 1910 ROSELAND BLVD, Tyler, TX 75701-4246
- **Phone:** (903) 533-0644
## 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:** Intermountain Medical Group Denver, LLC (NPI 1639784010, Aurora, CO), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2007
## Record status
- **NPPES last updated:** March 12, 2010
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Source: [NPI Profile](https://npiprofile.com/npi/1457561615) · Data from the CMS NPPES public registry.