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SCOTT DAVID WALLACE NP
NPI 1790442408
Nurse Practitioner - Family in Fairfield, CA

Active since November 17, 2021PECOS Enrolled
513 SILVERADO CIR, FAIRFIELD, CA 94534(707) 864-3240 Get Directions Write a Review

NPPES record last updated: November 17, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Scott David Wallace Np NPPES

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

SCOTT DAVID WALLACE NP (NPI 1790442408) is an individual family provider in Fairfield, California, licensed in California (459083) and active in the NPI registry since November 2021. He is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1790442408
Entity TypeIndividualMale
Primary Taxonomy363LF0000X
Provider Legal NameSCOTT DAVID WALLACECredential: NP
Location Address513 SILVERADO CIRFairfield, CA 94534-6818
Mailing Address513 Silverado CirFairfield, CA 94534-6818 · (707) 864-3240
Phone(707) 864-3240
Sole ProprietorYes
Medical School CMSOtherGraduated 2023
Enumeration DateNovember 17, 2021
NPPES CertifiedNovember 17, 2021
✔ NPI 1790442408 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in CA · 459083
513 SILVERADO CIR, Fairfield, CA 94534
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Scott David Wallace Np is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5991281750
PECOS Enrollment IDI20260112001034
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 Scott Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Lifelong Medical Care
13 mi
Family Medicine
25 CALIFORNIA ST
Rodeo, CA 94572
  • Reassigned Medicare billing, California enrollment
  • 241 clinicians in this Medicare group
NPI 1003289463 (510) 981-4100

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 94534 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
$98.85 typical visit price
range $65.02 – $191.95
Typical copayment $24.71 (range $16.25 – $47.98)
Most-billed visit code 99203
Established Patient
$113.05 typical visit price
range $21.86 – $157.69
Typical copayment $28.26 (range $5.46 – $39.42)
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.

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 Scott Wallace's NPI number?

The NPI number for Scott Wallace is 1790442408. It was assigned to this individual provider in the NPPES registry on November 17, 2021.

Where is Scott Wallace located?

Scott Wallace practices at 513 Silverado Cir, Fairfield, CA 94534. The listed phone number is (707) 864-3240.

What is Scott Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Scott Wallace enrolled in Medicare?

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

Which organization bills Medicare for Scott Wallace's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Scott Wallace reassigns Medicare benefits to Lifelong Medical Care (Rodeo, CA). 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 Scott Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Scott Wallace was last updated on November 17, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.