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DR. WALLACE DUNCAN M.D.
NPI 1821153529
Internal Medicine in Lithonia, GA

Active since December 25, 2006PECOS EnrolledAccepts Medicare Assignment
5900 HILLANDALE DR, ANNEX E, LITHONIA, GA 30058(770) 987-8400(770) 987-8494 Get Directions Write a Review

NPPES record last updated: October 17, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Wallace Duncan M.d. NPPES

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

DR. WALLACE DUNCAN M.D. (NPI 1821153529) is an individual internal medicine provider in Lithonia, Georgia, licensed in Georgia (041109) and active in the NPI registry since December 2006. He is enrolled in Medicare PECOS, is affiliated with Emory University Hospital, and is a graduate of Morehouse School Of Medicine (1992).

NPPES Registry Identity

NPI1821153529
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDR. WALLACE DUNCANCredential: M.D.
Location Address5900 HILLANDALE DR, ANNEX ELithonia, GA 30058-3802
Mailing AddressPo Box 924583Norcross, GA 30010-4583 · (770) 987-8400 · Fax (770) 987-8494
Phone(770) 987-8400
Fax(770) 987-8494
Sole ProprietorYes
Medical School CMSMorehouse School Of MedicineGraduated 1992
Enumeration DateDecember 25, 2006
Last NPPES UpdateOctober 17, 2011
✔ NPI 1821153529 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in GA · 041109
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
5900 HILLANDALE DR, Lithonia, GA 30058
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Other Identifiers 3

Medicare UPING21584GA
Medicare ID-Type Unspecified11BDTHFGA
Medicaid00687893GGA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama 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 and accepts Medicare assignment

Dr. Wallace Duncan M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6002707601
PECOS Enrollment IDI20040323000961
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 5

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.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
173 services77 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
171 services75 patients
Advance care planning, first 30 minutes 99497
Advance care planning is a process where you discuss your healthcare preferences with your doctor. This conversation, lasting up to 30 minutes, helps ensure your wishes are respected if you're unable to communicate them in the future. It's about your care, your way.
46 services45 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
38 services38 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
23 services13 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Emory University Hospital

Acute Care Hospitals · Atlanta, GA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number110010
Location1364 Clifton Road, NEAtlanta, GA 30322 · De Kalb County
Emergency services

Emory Hillandale Hospital

Acute Care Hospitals · Lithonia, GA
1/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number110226
Location2801 Dekalb Medical ParkwayLithonia, GA 30058 · De Kalb County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30058 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
$130.64 typical visit price
range $56.84 – $172.43
Typical copayment $32.66 (range $14.21 – $43.10)
Most-billed visit code 99204
Established Patient
$100.20 typical visit price
range $18.22 – $140.40
Typical copayment $25.05 (range $4.55 – $35.10)
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
98%8,908 patients4/55-star benchmark: 99%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
75%334 patients1/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
95%1,424 patients4/55-star benchmark: 97%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
100%1,424 patients5/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
36%1,424 patients2/55-star benchmark: 89%
View, Download, or Transmit (VDT)
At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.
23%1,424 patients
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
8 suppliers16 claims51 services$6.37 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
1 supplier12 claims12 services$169.80 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 18

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

THE ROSS ORTHOPAEDIC WELLNESS CENTER
Orthopaedic Surgery
5900 HILLANDALE DR, SUITE 215
LITHONIA, GA 30058
Dekalb County (678) 405-3252
DR. CLARICE MARIJETTA BELL M.D.
Family Medicine
5900 HILLANDALE DR, SUITE 215
LITHONIA, GA 30058
Dekalb County (770) 322-9660
DR. LAWRENCE F BRACK III M.D.
Ophthalmology
5900 HILLANDALE DR, SUITE 345
LITHONIA, GA 30058
Dekalb County (770) 987-0733
MRS. PENELOPE MARSHALL MCCOWN NP-C
Nurse Practitioner (Family)
5900 HILLANDALE DR, SUITE 215
LITHONIA, GA 30058
Dekalb County (770) 322-9660
RAY L HOWELL MD,MBA,FACOG,FICS
Obstetrics & Gynecology (Gynecology)
5900 HILLANDALE DR, SUITE 255
LITHONIA, GA 30058
Dekalb County (770) 593-8866
HILLANDALE PRIMARY CARE
Family Medicine
5900 HILLANDALE DR, SUITE 215
LITHONIA, GA 30058
Dekalb County (770) 322-9660
JADA EA MOORE-RUFFIN MD
Family Medicine
5900 HILLANDALE DR, SUITE 215
LITHONIA, GA 30058
Dekalb County (770) 322-9660
AILEEN ROBINSON NP
Nurse Practitioner
5900 HILLANDALE DR, ANNEX E
LITHONIA, GA 30058
Dekalb County (404) 446-3870

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 Wallace Duncan's NPI number?

The NPI number for Wallace Duncan is 1821153529. It was assigned to this individual provider in the NPPES registry on December 25, 2006.

Where is Wallace Duncan located?

Wallace Duncan practices at 5900 Hillandale Dr Annex E, Lithonia, GA 30058. The listed phone number is (770) 987-8400.

What is Wallace Duncan's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Wallace Duncan enrolled in Medicare?

Yes. Wallace Duncan is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Wallace Duncan accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Wallace Duncan 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.

Is Wallace Duncan affiliated with any hospitals?

According to CMS data, Wallace Duncan is affiliated with Emory University Hospital and Emory Hillandale Hospital.

When was this NPI record last updated?

The NPPES record for Wallace Duncan was last updated on October 17, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.