WELDON WALLACE MD
NPI 1679550875
Family Medicine in Grand Rapids, MI

Q: What is Weldon Wallace's NPI number?

The NPI number for Weldon Wallace is 1679550875. It was assigned to this individual provider in the NPPES registry on December 28, 2005.

Q: What is Weldon 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 Weldon Wallace was last updated on August 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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 December 28, 2005PECOS Enrolled

1260 EKHART ST NE, GRAND RAPIDS, MI 49503(616) 356-5202(616) 458-9845 Get Directions Write a Review

NPPES record last updated: August 10, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 10, 2026, Jul 13, 2026 (2 updates tracked since 2026).

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About Weldon Wallace Md NPPES

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

WELDON WALLACE MD (NPI 1679550875) is an individual family medicine provider in Grand Rapids, Michigan, licensed in Michigan (4301085136) and active in the NPI registry since December 2005. He is enrolled in Medicare PECOS, maintains a secondary practice location in Atlanta, and is a graduate of Howard University College Of Medicine (1996).

NPPES Registry Identity

NPI1679550875

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameWELDON WALLACECredential: MD

Location Address1260 EKHART ST NEGrand Rapids, MI 49503-1372

Mailing Address1260 Ekhart St Ne # 112Grand Rapids, MI 49503-1380 · (616) 356-5202 · Fax (616) 458-9845

Phone(616) 356-5202

Fax(616) 458-9845

Sole ProprietorNo

Medical School CMSHoward University College Of MedicineGraduated 1996

Enumeration DateDecember 28, 2005

Last NPPES UpdateAugust 10, 20262 updates tracked since enumeration

NPPES CertifiedAugust 10, 2026

✔ NPI 1679550875 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Licenses✔ Licensed in MI · 4301085136✔ Licensed in SC · 97022

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.

1260 EKHART ST NE, Grand Rapids, MI 49503

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Secondary Practice Location 1

Location 1PO Box 740013Atlanta, GA 30374-0013 · Phone (833) 804-1695 · Fax (312) 929-0373

Other Identifiers 1

Medicaid4752504MI

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Weldon Wallace Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3577590967

PECOS Enrollment IDI20260824001086

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 Weldon Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Oak Street Health Physicians Group Of South Carolina, LLC

586 mi

Primary Care

6119 WHITE HORSE RD STE 14
Greenville, SC 29611

Reassigned Medicare billing, South Carolina enrollment
40 clinicians in this Medicare group

NPI 1023614914 (312) 733-9730

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49503 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

$84.74 typical visit price

range $54.34 – $166.68

Typical copayment $21.18 (range $13.58 – $41.67)

Most-billed visit code 99203

Established Patient

$96.44 typical visit price

range $17.09 – $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.

KATHLEEN BARDSLEY

Behavior Analyst