JORDAN SCOTT WALLACE MD
NPI 1780210658
Pediatrics in Snoqualmie, WA

Q: What is Jordan Wallace's NPI number?

The NPI number for Jordan Wallace is 1780210658. It was assigned to this individual provider in the NPPES registry on March 22, 2020.

Q: What is Jordan Wallace's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Q: When was this NPI record last updated?

The NPPES record for Jordan Wallace was last updated on October 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.

Active since March 22, 2020PECOS Enrolled

9801 FRONTIER AVE SE, SNOQUALMIE, WA 98065(425) 831-2300 Get Directions Write a Review

NPPES record last updated: October 15, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Sep 10, 2024, Apr 11, 2024, Aug 14, 2023 and 2 more (5 updates tracked since 2020).

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About Jordan Scott Wallace Md NPPES

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

JORDAN SCOTT WALLACE MD (NPI 1780210658) is an individual pediatrics provider in Snoqualmie, Washington, licensed in Washington (MD61570069) and active in the NPI registry since March 2020. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1780210658

Entity TypeIndividualMale

Primary Taxonomy208000000X

Provider Legal NameJORDAN SCOTT WALLACECredential: MD

Location Address9801 FRONTIER AVE SESnoqualmie, WA 98065-5200

Mailing Address9801 Frontier Ave SeSnoqualmie, WA 98065-5200 · (425) 831-2300 · Fax (425) 396-7694

Phone(425) 831-2300

Sole ProprietorNo

Enumeration DateMarch 22, 2020

Last NPPES UpdateOctober 15, 20255 updates tracked since enumeration

NPPES CertifiedOctober 15, 2025

✔ NPI 1780210658 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in WA · MD61570069

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

9801 FRONTIER AVE SE, Snoqualmie, WA 98065

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Premera Blue Cross Blue Shield of Alaska, Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jordan Scott Wallace Md 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.

Medicare Billing Reassignment

Medicare enrollment records show Jordan Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Public Hospital District No 4 King County Washington

Same address

Critical Access

9801 FRONTIER AVE SE
Snoqualmie, WA 98065

Reassigned Medicare billing, Washington enrollment
Also billed through NPI 1144432634 (Washington)
144 clinicians in this Medicare group

NPI 1902846546 (425) 831-2300

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 98065 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

$97.43 typical visit price

range $63.67 – $189.37

Typical copayment $24.35 (range $15.91 – $47.34)

Most-billed visit code 99203

Established Patient

$111.00 typical visit price

range $21.12 – $155.00

Typical copayment $27.75 (range $5.28 – $38.75)

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.

PUBLIC HOSPITAL DISTRICT NO 4 KING COUNTY WASHINGTON

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