TRACY WALLACE MD
NPI 1720306558
Pediatrics in Gonzales, LA
About Tracy Wallace Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
TRACY WALLACE MD (NPI 1720306558) is an individual pediatrics provider in Gonzales, Louisiana, licensed in Louisiana (204717) and active in the NPI registry since May 2010. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Tracy Wallace Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Tracy Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Baton Rouge, LA 70808
- Reassigned Medicare billing, Louisiana enrollment
- 873 clinicians in this Medicare group
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 70737 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 8
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
GONZALES, LA 70737
GONZALES, LA 70737
GONZALES, LA 70737
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 Tracy Wallace's NPI number?
The NPI number for Tracy Wallace is 1720306558. It was assigned to this individual provider in the NPPES registry on May 4, 2010.
Where is Tracy Wallace located?
Tracy Wallace practices at 1937 S Burnside Ave, Gonzales, LA 70737. The listed phone number is (225) 765-5500.
What is Tracy Wallace's specialty?
The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.
Is Tracy Wallace enrolled in Medicare?
Yes. Tracy Wallace is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Tracy Wallace's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Tracy Wallace reassigns Medicare benefits to Our Lady Of The Lake Physician Group LLC (Baton Rouge, LA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Tracy Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Tracy Wallace accept?
Health plans from AmeriHealth Caritas Next, Blue Cross and Blue Shield of Louisiana, HMO Louisiana and UnitedHealthcare list Tracy 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.
When was this NPI record last updated?
The NPPES record for Tracy Wallace was last updated on May 19, 2021. 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.
# Tracy Wallace, MD · NPI 1720306558
Pediatrics physician in Gonzales, Louisiana. Individual provider, active in the CMS NPPES registry since May 4, 2010.
## Identity
- **NPI:** 1720306558 (Entity type: Individual)
- **Enumerated:** May 4, 2010
- **Primary specialty:** Pediatrics · taxonomy 208000000X
- **State license:** 204717 (Louisiana)
- **Sole proprietor:** No
## Practice location
- **Address:** 1937 S BURNSIDE AVE, Gonzales, LA 70737-4632
- **Phone:** (225) 765-5500 · **Fax:** (225) 644-9286
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Our Lady Of The Lake Physician Group LLC (NPI 1033494943, Baton Rouge, LA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 19, 2021
- **Other identifiers:** Medicaid 2103831 (LA)
---
Source: [NPI Profile](https://npiprofile.com/npi/1720306558) · Data from the CMS NPPES public registry.