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NICHOLE GREEN WALLACE MD
NPI 1497729909
Pediatrics in Tulsa, OK

Active since February 14, 2006PECOS Enrolled
4444 E 41ST ST, 2ND FLOOR, STE A, TULSA, OK 74135(918) 619-4300(918) 619-4322 Get Directions Write a Review

NPPES record last updated: April 7, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Nichole Green Wallace Md NPPES

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

NICHOLE GREEN WALLACE MD (NPI 1497729909) is an individual pediatrics provider in Tulsa, Oklahoma, licensed in Oklahoma (23314) and active in the NPI registry since February 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1497729909
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameNICHOLE GREEN WALLACECredential: MD
Location Address4444 E 41ST ST, 2ND FLOOR, STE ATulsa, OK 74135-2527
Mailing AddressPo Box 268838Oklahoma City, OK 73126-8838 · (918) 660-3632 · Fax (918) 660-3631
Phone(918) 619-4300
Fax(918) 619-4322
Sole ProprietorNo
Enumeration DateFebruary 14, 2006
Last NPPES UpdateApril 7, 2008
✔ NPI 1497729909 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in OK · 23314
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
4444 E 41ST ST, Tulsa, OK 74135
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Other Names 1

Former Name (1)Suzanne Nichole Green

Other Identifiers 1

Medicare UPINI02718

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Medica.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nichole Green Wallace Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 74135 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
$82.46 typical visit price
range $53.00 – $162.61
Typical copayment $20.61 (range $13.25 – $40.65)
Most-billed visit code 99203
Established Patient
$94.27 typical visit price
range $16.68 – $132.40
Typical copayment $23.56 (range $4.17 – $33.10)
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.

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.

JOHN MAXWELL CARMENT MD
Internal Medicine (Geriatric Medicine)
4444 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 619-4400
JESSICA CANNON LCSW
Social Worker (Clinical)
4444 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 619-4400
DA YOUNG SEO
Student in an Organized Health Care Education/Training Program
4444 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 619-4400
DR. TARA ROMASANTA BUCK M.D.
Psychiatry & Neurology (Child & Adolescent Psychiatry)
4444 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 660-3130
CARMEN M GENT D.O.
Pediatrics
4444 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 619-4400
WILLIAM ANCIL OGILVIE MD
Student in an Organized Health Care Education/Training Program
4444 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 619-4400
RACHEL NICHOLS
Student in an Organized Health Care Education/Training Program
4444 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 619-4400
PETER RICHARD NELSON MD, MS
Surgery (Vascular Surgery)
4444 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 619-4400

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 Nichole Wallace's NPI number?

The NPI number for Nichole Wallace is 1497729909. It was assigned to this individual provider in the NPPES registry on February 14, 2006. The provider is also known as Suzanne Nichole Green.

Where is Nichole Wallace located?

Nichole Wallace practices at 4444 E 41st St 2nd Floor, Ste A, Tulsa, OK 74135. The listed phone number is (918) 619-4300.

What is Nichole Wallace's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Nichole Wallace enrolled in Medicare?

Yes. Nichole Wallace is registered in the Medicare PECOS enrollment system.

What insurance does Nichole Wallace accept?

Health plans from Medica list Nichole 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 Nichole Wallace was last updated on April 7, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.