AMY JO WALLACE MD
NPI 1467487322
Pediatrics in Kernersville, NC
About Amy Jo Wallace Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
AMY JO WALLACE MD (NPI 1467487322) is an individual pediatrics provider in Kernersville, North Carolina, licensed in North Carolina (200600865) and active in the NPI registry since July 2006. She is enrolled in Medicare PECOS and maintains a secondary practice location in Kernersville.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Amy Jo Wallace Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Amy Jo Wallace reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Kernersville, NC 27284
- Reassigned Medicare billing, North Carolina enrollment
- 583 clinicians in this Medicare group
Winston Salem, NC 27157
- Reassigned Medicare billing, North Carolina enrollment
- 3,003 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 27284 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 5
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
KERNERSVILLE, NC 27284
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 Amy Jo Wallace's NPI number?
The NPI number for Amy Jo Wallace is 1467487322. It was assigned to this individual provider in the NPPES registry on July 11, 2006.
Where is Amy Jo Wallace located?
Amy Jo Wallace practices at 861 Old Winston Rd Ste 101, Kernersville, NC 27284. The listed phone number is (336) 904-0143.
What is Amy Jo Wallace's specialty?
The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.
Is Amy Jo Wallace enrolled in Medicare?
Yes. Amy Jo Wallace is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Amy Jo Wallace's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Amy Jo Wallace reassigns Medicare benefits to 2 organizations: Wake Forest Health Network LLC (Kernersville, NC) and Wake Forest University Health Sciences (Winston Salem, 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 Amy Jo Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Amy Jo Wallace accept?
Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and AmeriHealth Caritas Next and 3 other insurers list Amy Jo 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 Amy Jo Wallace was last updated on November 4, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Amy Jo Wallace, MD · NPI 1467487322
Pediatrics physician in Kernersville, North Carolina. Individual provider, active in the CMS NPPES registry since July 11, 2006.
## Identity
- **NPI:** 1467487322 (Entity type: Individual)
- **Enumerated:** July 11, 2006
- **Primary specialty:** Pediatrics · taxonomy 208000000X
- **State license:** 200600865 (North Carolina)
- **Sole proprietor:** No
## Practice location
- **Address:** 861 OLD WINSTON RD STE 101, Kernersville, NC 27284-7141
- **Phone:** (336) 904-0143 · **Fax:** (336) 904-0046
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **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): Wake Forest Health Network LLC (NPI 1487879177, Kernersville, NC); Wake Forest University Health Sciences (NPI 1003803032, Winston Salem, NC) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 4, 2020
---
Source: [NPI Profile](https://npiprofile.com/npi/1467487322) · Data from the CMS NPPES public registry.