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CARLY WALLACE DO
NPI 1700562766
Student in an Organized Health Care Education/Training Program in Ypsilanti, MI

Active since June 26, 2023PECOS Enrolled
5333 MCAULEY DR STE R-5003, YPSILANTI, MI 48197(734) 712-3376(734) 887-8943 Get Directions Write a Review

NPPES record last updated: September 15, 2025. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Sep 15, 2025, Dec 2, 2024 (2 updates tracked since 2024).

About Carly Wallace Do NPPES

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

CARLY WALLACE DO (NPI 1700562766) is an individual student in an organized health care education/training program in Ypsilanti, Michigan, licensed in Georgia (15182) and active in the NPI registry since June 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1700562766
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameCARLY WALLACECredential: DO
Location Address5333 MCAULEY DR STE R-5003Ypsilanti, MI 48197-1014
Mailing Address5333 Mcauley Dr Ste R-5003Ypsilanti, MI 48197-1014 · (734) 712-3376 · Fax (734) 887-8943
Phone(734) 712-3376
Fax(734) 887-8943
Sole ProprietorNo
Enumeration DateJune 26, 2023
Last NPPES UpdateSeptember 15, 20252 updates tracked since enumeration
NPPES CertifiedSeptember 15, 2025
✔ NPI 1700562766 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
License✔ Licensed in GA · 15182
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
5333 MCAULEY DR STE R-5003, Ypsilanti, MI 48197
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Carly Wallace Do 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.

Other Providers at the Same Location NPPES

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

MORGAN LYNN ZUEGER
Student in an Organized Health Care Education/Training Program
5333 MCAULEY DR STE R-5003
YPSILANTI, MI 48197
Washtenaw County (734) 712-3376

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 Carly Wallace's NPI number?

The NPI number for Carly Wallace is 1700562766. It was assigned to this individual provider in the NPPES registry on June 26, 2023.

Where is Carly Wallace located?

Carly Wallace practices at 5333 Mcauley Dr Ste R-5003, Ypsilanti, MI 48197. The listed phone number is (734) 712-3376.

What is Carly Wallace's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Carly Wallace enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Carly Wallace was last updated on September 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.