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JORDAN SCOTT WALLACE MD
NPI 1780210658
Pediatrics in Snoqualmie, WA

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: August 09, 2026.

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

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 Premera Blue Cross Blue Shield of Alaska, Providence Health Plan.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)

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.

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
Clinical Medical Laboratory
9801 FRONTIER AVE SE
SNOQUALMIE, WA 98065
King County (425) 831-2321
AMBER MARIE DEITERING RN
Registered Nurse
9801 FRONTIER AVE SE
SNOQUALMIE, WA 98065
King County (425) 831-3428
RON E BENNETT RPH
Pharmacist
9801 FRONTIER AVE SE
SNOQUALMIE, WA 98065
King County (425) 831-3407
DIMA KARIM
Speech-Language Pathologist
9801 FRONTIER AVE SE
SNOQUALMIE, WA 98065
King County (425) 831-2300
JONATHAN HALPER MD
Emergency Medicine
9801 FRONTIER AVE SE
SNOQUALMIE, WA 98065
King County (425) 831-2300
PATRICIA JEANNE YETNEBERK ARNP
Nurse Practitioner
9801 FRONTIER AVE SE
SNOQUALMIE, WA 98065
King County (425) 831-2313
PUBLIC HOSPITAL DISTRICT NO 4, KING COUNTY WA
Family Medicine
9801 FRONTIER AVE SE
SNOQUALMIE, WA 98065
King County (425) 831-2321
EMILIA LEWIS PA-C
Physician Assistant
9801 FRONTIER AVE SE
SNOQUALMIE, WA 98065
King County (425) 831-2300

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 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.

Where is Jordan Wallace located?

Jordan Wallace practices at 9801 Frontier Ave SE, Snoqualmie, WA 98065. The listed phone number is (425) 831-2300.

What is Jordan Wallace's specialty?

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

Is Jordan Wallace enrolled in Medicare?

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

What insurance does Jordan Wallace accept?

Health plans from Premera Blue Cross Blue Shield of Alaska and Providence Health Plan list Jordan 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 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 9 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.