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KIMBERLY LANE WALLACE NP-C
NPI 1619688116
Nurse Practitioner - Primary Care in Beavercreek, OH

Active since December 06, 2022PECOS EnrolledAccepts Medicare Assignment
3535 PENTAGON BLVD, BEAVERCREEK, OH 45431(937) 702-4000 Get Directions Write a Review

NPPES record last updated: December 6, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Kimberly Lane Wallace Np-c NPPES

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

KIMBERLY LANE WALLACE NP-C (NPI 1619688116) is an individual primary care provider in Beavercreek, Ohio, licensed in Ohio (APRN.CNP.0032777) and active in the NPI registry since December 2022. She is enrolled in Medicare PECOS, is affiliated with Miami Valley Hospital, and is a graduate of Other (2022).

NPPES Registry Identity

NPI1619688116
Entity TypeIndividualFemale
Primary Taxonomy363LP2300X
Provider Legal NameKIMBERLY LANE WALLACECredential: NP-C
Location Address3535 PENTAGON BLVDBeavercreek, OH 45431-1705
Mailing Address935 Salem StBrookville, OH 45309-8225 · (937) 344-5173
Phone(937) 702-4000
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateDecember 6, 2022
NPPES CertifiedDecember 6, 2022
✔ NPI 1619688116 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
License✔ Licensed in OH · APRN.CNP.0032777
3535 PENTAGON BLVD, Beavercreek, OH 45431
Open in Google Maps ↗

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

Kimberly Lane Wallace Np-c 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 ID9739550666
PECOS Enrollment IDI20230131003264
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 8

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.
185 services146 patients
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month 99490
Chronic care management services involve a healthcare professional directing clinical staff in managing your chronic conditions. This includes the first 20 minutes per month of services like medication management, care coordination, and health monitoring to help improve your health and quality of life.
70 services20 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.
56 services54 patients
New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205
This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
35 services35 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
33 services22 patients
Automated urinalysis test 81003
An automated urinalysis test is a routine examination that checks your urine for various substances. It can help identify potential health issues such as kidney problems or diabetes. The test uses a machine to analyze a small urine sample, providing quick and accurate results.
30 services30 patients

Hospital Affiliations CMS Care Compare 2

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

Miami Valley Hospital

Acute Care Hospitals · Dayton, OH
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number360051
LocationOne Wyoming StreetDayton, OH 45409 · Montgomery County
Emergency services Birthing friendly

Kettering Health Dayton

Acute Care Hospitals · Dayton, OH
3/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number360133
Location405 Grand AvenueDayton, OH 45405 · Montgomery County
Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45431 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
$84.72 typical visit price
range $54.34 – $166.65
Typical copayment $21.18 (range $13.58 – $41.66)
Most-billed visit code 99203
Established Patient
$96.44 typical visit price
range $17.10 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
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.

ASHLEY GEORGE
Nurse Anesthetist, Certified Registered
3535 PENTAGON BLVD
BEAVERCREEK, OH 45431
Greene County (937) 702-4000
EMILY GRACE TROMPAK (O'NEAL) PA-C
Physician Assistant (Medical)
3535 PENTAGON BLVD
BEAVERCREEK, OH 45431
Greene County (937) 702-4450
DR. ADELAIDE OMANE CRNA
Nurse Anesthetist, Certified Registered
3535 PENTAGON BLVD
BEAVERCREEK, OH 45431
Greene County (937) 702-4000
GREENE MEMORIAL HOSPITAL SERVICES, INC
Obstetrics & Gynecology
3535 PENTAGON BLVD, SUITE 220
BEAVERCREEK, OH 45431
Greene County (937) 429-7350
MARIAN GAIDA PHAM NP
Nurse Practitioner (Gerontology)
3535 PENTAGON BLVD
BEAVERCREEK, OH 45431
Greene County (937) 395-6665
DR. DANIEL B LUCKENBILL MD
Orthopaedic Surgery (Sports Medicine)
3535 PENTAGON BLVD, STE 320
BEAVERCREEK, OH 45431
Greene County (937) 433-5309
MRS. RAEANNE HUNTER FONDRIEST AG-ACNP
Nurse Practitioner (Acute Care)
3535 PENTAGON BLVD
BEAVERCREEK, OH 45431
Greene County (937) 702-4024
LINDSEY NICOLE ELLIOTT APRN
Nurse Practitioner (Acute Care)
3535 PENTAGON BLVD
BEAVERCREEK, OH 45431
Greene County (937) 702-4000

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 Kimberly Wallace's NPI number?

The NPI number for Kimberly Wallace is 1619688116. It was assigned to this individual provider in the NPPES registry on December 6, 2022.

Where is Kimberly Wallace located?

Kimberly Wallace practices at 3535 Pentagon Blvd, Beavercreek, OH 45431. The listed phone number is (937) 702-4000.

What is Kimberly Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Is Kimberly Wallace enrolled in Medicare?

Yes. Kimberly 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 Kimberly Wallace accept?

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

According to CMS data, Kimberly Wallace is affiliated with Miami Valley Hospital and Kettering Health Dayton.

When was this NPI record last updated?

The NPPES record for Kimberly Wallace was last updated on December 6, 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.