LOURDES IVETTE WALLACE AGACNP-BC
NPI 1659773869
Nurse Practitioner - Adult Health in Boerne, TX

Q: What is Lourdes Wallace's NPI number?

The NPI number for Lourdes Wallace is 1659773869. It was assigned to this individual provider in the NPPES registry on September 18, 2014.

Q: What is Lourdes Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Q: When was this NPI record last updated?

The NPPES record for Lourdes Wallace was last updated on September 3, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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 September 18, 2014PECOS Enrolled

113 PLEASANT VALLEY DR STE 210, BOERNE, TX 78006(830) 267-4575(830) 267-4575 Get Directions Write a Review

NPPES record last updated: September 3, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 3, 2020, Mar 17, 2018, Jan 19, 2018 and 1 more (4 updates tracked since 2015).

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About Lourdes Ivette Wallace Agacnp-bc NPPES

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

LOURDES IVETTE WALLACE AGACNP-BC (NPI 1659773869) is an individual adult health provider in Boerne, Texas, licensed in Texas (AP126548) and active in the NPI registry since September 2014. She is enrolled in Medicare PECOS and maintains a secondary practice location in Boerne.

NPPES Registry Identity

NPI1659773869

Entity TypeIndividualFemale

Primary Taxonomy363LA2200X

Provider Legal NameLOURDES IVETTE WALLACECredential: AGACNP-BC

Location Address113 PLEASANT VALLEY DR STE 210Boerne, TX 78006-5683

Mailing Address113 Pleasant Valley Dr Ste 210Boerne, TX 78006-5683 · (830) 267-4575 · Fax (830) 267-4575

Phone(830) 267-4575

Fax(830) 267-4575

Sole ProprietorNo

Enumeration DateSeptember 18, 2014

Last NPPES UpdateSeptember 3, 20204 updates tracked since enumeration

NPPES CertifiedSeptember 3, 2020

✔ NPI 1659773869 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LA2200X

Licenses✔ Licensed in TX · AP126548✔ Licensed in UT · 11670071-4405

Also ListedNurse PractitionerTaxonomy 363L00000X · License RN860816 (TX)

Also ListedNurse Practitioner · GerontologyTaxonomy 363LG0600X · License AP126548 (TX), 11670071-4405 (UT)

113 PLEASANT VALLEY DR STE 210, Boerne, TX 78006

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Secondary Practice Location 1

Location 110004 Johns RdBoerne, TX 78006-8811 · Phone (830) 267-4575 · Fax (830) 267-4575

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Imperial Insurance Companies, Inc..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)

Lourdes Ivette Wallace Agacnp-bc 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 78006 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

$84.92 typical visit price

range $54.84 – $166.88

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

Most-billed visit code 99203

Established Patient

$97.05 typical visit price

range $17.52 – $136.11

Typical copayment $24.26 (range $4.38 – $34.02)

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.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390

DME-Oxygen and Supplies · category DC002N

2 suppliers41 claims41 services$62.45 avg. paid by Medicare

Portable oxygen concentrator, rental E1392

DME-Oxygen and Supplies · category DC002N

1 supplier38 claims38 services$30.68 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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.

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