GREGORY WALLACE D.O.
NPI 1558701250
Family Medicine in Fort Drum, NY

Q: What is Gregory Wallace's NPI number?

The NPI number for Gregory Wallace is 1558701250. It was assigned to this individual provider in the NPPES registry on June 27, 2013.

Q: What is Gregory Wallace's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Gregory Wallace was last updated on July 27, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.

Active since June 27, 2013PECOS EnrolledAccepts Medicare Assignment

11050 MOUNT BELVEDERE BLVD, FORT DRUM, NY 13602(315) 772-5662 Get Directions Write a Review

NPPES record last updated: July 27, 2018. Verified against the NPPES registry weekly; last sync: September 06, 2026.

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About Gregory Wallace D.o. NPPES

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

GREGORY WALLACE D.O. (NPI 1558701250) is an individual family medicine provider in Fort Drum, New York, licensed in Indiana (02004547A) and active in the NPI registry since June 2013. He is enrolled in Medicare PECOS, is affiliated with West Jersey Hospital, and maintains a secondary practice location in Fort Bragg.

NPPES Registry Identity

NPI1558701250

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameGREGORY WALLACECredential: D.O.

Location Address11050 MOUNT BELVEDERE BLVDFort Drum, NY 13602

Mailing Address11050 Mount Belvedere BlvdFort Drum, NY 13602-5438

Phone(315) 772-5662

Sole ProprietorNo

Medical School CMSPhiladelphia College Of Osteopathic MedicineGraduated 2013

Enumeration DateJune 27, 2013

Last NPPES UpdateJuly 27, 2018

✔ NPI 1558701250 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in IN · 02004547A

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

11050 MOUNT BELVEDERE BLVD, Fort Drum, NY 13602

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Secondary Practice Location 1

Location 12817 Reilly St, Womack Army Medical CenterFort Bragg, NC 28310-7324 · Phone (910) 907-8922 · Fax (910) 907-6069

Accepted Insurance

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

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

Gregory Wallace D.o. 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 ID446570782

PECOS Enrollment IDI20200330003754

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 13

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.

336 services180 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.

163 services131 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

106 services106 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.

34 services34 patients

Injection, dexamethasone sodium phosphate, 1 mg J1100

Dexamethasone sodium phosphate is a medication given via injection. It is a type of steroid that helps reduce inflammation and immune responses. It can be used to treat a variety of conditions, such as allergies, skin conditions, arthritis, and more.

29 services16 patients

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report 93000

An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.

26 services26 patients

Administration of influenza virus vaccine G0008

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

21 services21 patients

Influenza vaccine split virus, preservative free 90662

The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.

20 services20 patients

Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677

The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.

19 services19 patients

Administration of pneumococcal vaccine G0009

The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.

15 services15 patients

Aspiration and/or injection of fluid from large joint 20610

This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.

13 services11 patients

Transitional care management services for problem of at least moderate complexity 99495

Transitional care management services focus on coordinating and managing your care after you leave the hospital. For moderate complexity problems, this involves managing your medications, arranging further treatments, and ensuring you have the necessary follow-ups.

11 services11 patients

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment G0402

An Initial Preventive Physical Examination, also known as a "Welcome to Medicare" visit, is a one-time, face-to-face visit during your first 12 months of Medicare enrollment. It includes a review of your health, as well as education and counseling about preventive services and further screenings.

11 services11 patients

Hospital Affiliations CMS Care Compare 2

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

West Jersey Hospital

Acute Care Hospitals · Voorhees, NJ

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number310022

Location100 Bowman DriveVoorhees, NJ 08043 · Camden County

Emergency services Birthing friendly

Virtua Our Lady Of Lourdes Hospital

Acute Care Hospitals · Camden, NJ

1/5 CMS rating

OwnershipGovernment - State

CMS Certification Number310029

Location1600 Haddon AvenueCamden, NJ 08103 · Camden County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 13602 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

$84.93 typical visit price

range $54.87 – $166.88

Typical copayment $21.23 (range $13.71 – $41.72)

Most-billed visit code 99203

Established Patient

$97.08 typical visit price

range $17.54 – $136.14

Typical copayment $24.27 (range $4.38 – $34.03)

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.

DR. LAUREL JARVIS PH.D.

Psychologist (Clinical)

11050 MOUNT BELVEDERE BLVD, BEHAVIORAL HEALTH DEPARTMENT, MEDDAC
FORT DRUM, NY 13602

Jefferson County (315) 772-4850

DAVID LEWIS KEYES RPA-C

Physician Assistant

11050 MOUNT BELVEDERE BLVD, USA MEDDAC CREDENTIALS
FORT DRUM, NY 13602

Jefferson County (315) 772-5508

BRADY SIMPKINS PA-C

Physician Assistant

11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602

Jefferson County (802) 258-0301

MS. MARY ANGELA MACCULLOCH LCSW

Social Worker (Clinical)

11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602

Jefferson County (315) 772-7624

DR. ISAAC P MILLS DO

Family Medicine

11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602

Jefferson County (315) 772-2778

SAVITRI MOTAPARTHI M.D.

Pediatrics

11050 MOUNT BELVEDERE BLVD, USA MEDDAC /CREDENTIALS
FORT DRUM, NY 13602

Jefferson County (315) 772-4025

DR. LUTHER ROSWELL WIEST D.O.

Family Medicine

11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602

Jefferson County (315) 772-3679

MADISON GERMAN LCSW

Social Worker (Clinical)

11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602

Jefferson County (315) 772-2778

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 Gregory Wallace's NPI number?

The NPI number for Gregory Wallace is 1558701250. It was assigned to this individual provider in the NPPES registry on June 27, 2013.

Where is Gregory Wallace located?

Gregory Wallace practices at 11050 Mount Belvedere Blvd, Fort Drum, NY 13602. The listed phone number is (315) 772-5662.

What is Gregory Wallace's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Gregory Wallace enrolled in Medicare?

Yes. Gregory 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.

What insurance does Gregory Wallace accept?

Health plans from Molina Healthcare list Gregory 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 Gregory Wallace affiliated with any hospitals?

According to CMS data, Gregory Wallace is affiliated with West Jersey Hospital and Virtua Our Lady Of Lourdes Hospital.

When was this NPI record last updated?

The NPPES record for Gregory Wallace was last updated on July 27, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.