KACIE WALLACE M.S., PA-C
NPI 1750871455
Physician Assistant in Detroit, MI

Q: What is Kacie Wallace's NPI number?

The NPI number for Kacie Wallace is 1750871455. It was assigned to this individual provider in the NPPES registry on May 17, 2018.

Q: What is Kacie Wallace's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Kacie Wallace was last updated on September 15, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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 May 17, 2018PECOS Enrolled

22101 MOROSS RD, DETROIT, MI 48236(313) 343-4000 Get Directions Write a Review

NPPES record last updated: September 15, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 15, 2019, Jul 25, 2019, May 17, 2018 (3 updates tracked since 2018).

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About Kacie Wallace M.s., Pa-c NPPES

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

KACIE WALLACE M.S., PA-C (NPI 1750871455) is an individual physician assistant in Detroit, Michigan, licensed in Michigan (1151843) and active in the NPI registry since May 2018. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1750871455

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameKACIE WALLACECredential: M.S., PA-C

Location Address22101 MOROSS RDDetroit, MI 48236-2148

Mailing Address226 Wimpole DrRochester Hills, MI 48309-2148 · (248) 720-8197

Phone(313) 343-4000

Sole ProprietorNo

Enumeration DateMay 17, 2018

Last NPPES UpdateSeptember 15, 20193 updates tracked since enumeration

✔ NPI 1750871455 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in MI · 1151843

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

22101 MOROSS RD, Detroit, MI 48236

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.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)

Kacie Wallace M.s., Pa-c 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.

Areas of Expertise CMS Part B claims 2

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.

Emergency department visit with moderate level of medical decision making 99284

An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.

13 services13 patients

Emergency department visit with high level of medical decision making 99285

An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.

11 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48236 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

$90.76 typical visit price

range $58.04 – $177.36

Typical copayment $22.69 (range $14.51 – $44.34)

Most-billed visit code 99203

Established Patient

$72.38 typical visit price

range $18.32 – $143.49

Typical copayment $18.09 (range $4.58 – $35.87)

Most-billed visit code 99213

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.

MARY DECAROLIS LMSW, ACSW

Social Worker (Clinical)