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MR. TIMOTHY WALLACE CDCA
NPI 1619527611
Case Manager/Care Coordinator in Columbus, OH

Active since September 12, 2019PECOS Enrolled
774 INTERNET DR, COLUMBUS, OH 43207(614) 443-5454 Get Directions Write a Review

NPPES record last updated: December 28, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 29, 2024, Dec 28, 2022, Sep 12, 2019 (3 updates tracked since 2019).

About Mr. Timothy Wallace Cdca NPPES

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

MR. TIMOTHY WALLACE CDCA (NPI 1619527611) is an individual case manager/care coordinator provider in Columbus, Ohio and active in the NPI registry since September 2019. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1619527611
Entity TypeIndividualMale
Primary Taxonomy171M00000X
Provider Legal NameMR. TIMOTHY WALLACECredential: CDCA
Location Address774 INTERNET DRColumbus, OH 43207-2589
Mailing Address774 Internet DrColumbus, OH 43207-2589 · (614) 443-5454
Phone(614) 443-5454
Sole ProprietorYes
Enumeration DateSeptember 12, 2019
Last NPPES UpdateDecember 28, 20223 updates tracked since enumeration
NPPES CertifiedDecember 28, 2022
✔ NPI 1619527611 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCase Manager/Care CoordinatorOther Service Providers
Taxonomy Code171M00000X
Definition
A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee's progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management.
774 INTERNET DR, Columbus, OH 43207
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource, MedMutual and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Timothy Wallace Cdca 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.

Medicare Billing Reassignment

Medicare enrollment records show Timothy Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Grow Healthcare Group PA
988 mi
Mental Health
66 W FLAGLER ST STE 900
Miami, FL 33130
  • Reassigned Medicare billing, Ohio enrollment
  • 725 clinicians in this Medicare group
NPI 1245845932 (786) 244-7711

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 18

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EMILY LYNN LOWE MSSA, LISW-S
Social Worker (Clinical)
774 INTERNET DR
COLUMBUS, OH 43207
Franklin County (614) 443-5454
MR. ZACHARY JOHNSON
Case Manager/Care Coordinator
774 INTERNET DR
COLUMBUS, OH 43207
Franklin County (614) 443-5454
MS. JESSICA ANN VOGEL
Case Manager/Care Coordinator
774 INTERNET DR
COLUMBUS, OH 43207
Franklin County (614) 443-5454
MRS. MARISSA MINETTE QMHS
Case Manager/Care Coordinator
774 INTERNET DR
COLUMBUS, OH 43207
Franklin County (614) 443-5454
SAVANNAH C FLANNERY
Case Manager/Care Coordinator
774 INTERNET DR
COLUMBUS, OH 43207
Franklin County (614) 443-5454
IRMA MARIE DOTTO QMHP
Case Manager/Care Coordinator
774 INTERNET DR
COLUMBUS, OH 43207
Franklin County (614) 443-5454
ELIZABETH JURDEN LSW
Social Worker (Clinical)
774 INTERNET DR
COLUMBUS, OH 43207
Franklin County (614) 443-5454
MERCY GONZALEZ LSW
Social Worker
774 INTERNET DR
COLUMBUS, OH 43207
Franklin County (614) 443-5454

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 Timothy Wallace's NPI number?

The NPI number for Timothy Wallace is 1619527611. It was assigned to this individual provider in the NPPES registry on September 12, 2019.

Where is Timothy Wallace located?

Timothy Wallace practices at 774 Internet Dr, Columbus, OH 43207. The listed phone number is (614) 443-5454.

What is Timothy Wallace's specialty?

The primary specialty registered for this NPI is Case Manager/Care Coordinator with taxonomy code 171M00000X.

Is Timothy Wallace enrolled in Medicare?

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

Which organization bills Medicare for Timothy Wallace's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Timothy Wallace reassigns Medicare benefits to Grow Healthcare Group PA (Miami, FL). 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 Timothy Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Timothy Wallace accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource, MedMutual, Oscar Health Insurance and Oscar Insurance Corporation of Ohio and 1 other insurer list Timothy 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 Timothy Wallace was last updated on December 28, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.