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DR. ILISA DAWN WALLACH M.D.
NPI 1629139340
Internal Medicine in New York, NY

Active since December 13, 2006PECOS EnrolledAccepts Medicare Assignment
1421 3RD AVE FL 5, NEW YORK, NY 10028(212) 717-5700(212) 717-5706 Get Directions Write a Review

NPPES record last updated: February 2, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Ilisa Dawn Wallach M.d. NPPES

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

DR. ILISA DAWN WALLACH M.D. (NPI 1629139340) is an individual internal medicine provider in New York, New York, licensed in New York (176452) and active in the NPI registry since December 2006. She is enrolled in Medicare PECOS, is affiliated with Maimonides Medical Center, and is a graduate of New York Medical College (1987).

NPPES Registry Identity

NPI1629139340
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameDR. ILISA DAWN WALLACHCredential: M.D.
Location Address1421 3RD AVE FL 5New York, NY 10028-1899
Mailing Address1421 3rd Ave Fl 5New York, NY 10028-1899 · (212) 717-5700 · Fax (212) 717-5706
Phone(212) 717-5700
Fax(212) 717-5706
Sole ProprietorYes
Medical School CMSNew York Medical CollegeGraduated 1987
Enumeration DateDecember 13, 2006
Last NPPES UpdateFebruary 2, 2016
✔ NPI 1629139340 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in NY · 176452
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedInternal Medicine · Cardiovascular DiseaseTaxonomy 207RC0000X · License 176452 (NY)
1421 3RD AVE FL 5, New York, NY 10028
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Other Names 1

Professional Name (2)Dr. Ilisa Dawn Wallach Md

Other Identifiers 2

Medicare UPINF47098NY
Medicare ID-Type Unspecified26H211NY

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

Dr. Ilisa Dawn Wallach M.d. 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 ID42377426
PECOS Enrollment IDI20090330000611
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 3

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 high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
60 services44 patients
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.
49 services35 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.
28 services28 patients

Hospital Affiliations CMS Care Compare

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

Maimonides Medical Center

Acute Care Hospitals · Brooklyn, NY
1/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number330194
Location4802 Tenth AvenueBrooklyn, NY 11219 · Kings County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10028 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
$150.24 typical visit price
range $65.69 – $198.19
Typical copayment $37.56 (range $16.42 – $49.54)
Most-billed visit code 99204
Established Patient
$114.88 typical visit price
range $21.20 – $160.66
Typical copayment $28.72 (range $5.30 – $40.16)
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.

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 Ilisa Wallach's NPI number?

The NPI number for Ilisa Wallach is 1629139340. It was assigned to this individual provider in the NPPES registry on December 13, 2006. The provider is also known as Dr. Ilisa Dawn Wallach MD.

Where is Ilisa Wallach located?

Ilisa Wallach practices at 1421 3rd Ave Fl 5, New York, NY 10028. The listed phone number is (212) 717-5700.

What is Ilisa Wallach's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Ilisa Wallach enrolled in Medicare?

Yes. Ilisa Wallach 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.

Is Ilisa Wallach affiliated with any hospitals?

According to CMS data, Ilisa Wallach is affiliated with Maimonides Medical Center.

When was this NPI record last updated?

The NPPES record for Ilisa Wallach was last updated on February 2, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.