RAFAELLA IZAR WALLACE ANP
NPI 1821469107
Nurse Practitioner - Gerontology in Fort Worth, TX

Active since October 13, 2015PECOS EnrolledAccepts Medicare Assignment
89.44/100
CMS Quality Rating
500 S HENDERSON ST STE 200, FORT WORTH, TX 76104(817) 413-1500(817) 413-1499 Get Directions Write a Review

NPPES record last updated: December 1, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Dec 1, 2021, May 26, 2021, Feb 20, 2017 and 1 more (4 updates tracked since 2016).

About Rafaella Izar Wallace Anp NPPES

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

RAFAELLA IZAR WALLACE ANP (NPI 1821469107) is an individual gerontology provider in Fort Worth, Texas, licensed in Texas (AP129253) and active in the NPI registry since October 2015. She is enrolled in Medicare PECOS and is a graduate of Other (2015).

NPPES Registry Identity

NPI1821469107
Entity TypeIndividualFemale
Primary Taxonomy363LG0600X
Provider Legal NameRAFAELLA IZAR WALLACECredential: ANP
Location Address500 S HENDERSON ST STE 200Fort Worth, TX 76104-2154
Mailing AddressPo Box 911230Dallas, TX 75391-1230 · (972) 997-8000 · Fax (972) 234-2987
Fax(817) 413-1499
Sole ProprietorNo
Medical School CMSOtherGraduated 2015
Enumeration DateOctober 13, 2015
Last NPPES UpdateDecember 1, 20214 updates tracked since enumeration
NPPES CertifiedDecember 1, 2021
NPI 1821469107 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyNurse Practitioner · GerontologyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LG0600X
License Licensed in TX · AP129253
Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X · License AP129253 (TX)
500 S HENDERSON ST STE 200, Fort Worth, TX 76104

Other Identifiers 2

Medicaid365509402TX
Other8449NZTX · Blue Cross Blue Shield

Accepted 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

Rafaella Izar Wallace Anp 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 ID4082919238
PECOS Enrollment IDI20160225000996
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 19

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.

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.
351 services174 patients
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count 85025
A Complete Blood Cell Count is a common test that measures various components of the blood, including red cells (carry oxygen), white cells (fight infection), and platelets (help blood clot). An automated test ensures accuracy. The differential count provides detailed information about white cell types.
330 services167 patients
Flow cytometry technique for dna or cell analysis, each additional marker 88185
Flow cytometry is a technique that helps analyze the physical and chemical characteristics of cells or particles. When an additional marker is used, it aids in identifying specific cell types or stages of disease. This helps in precise diagnosis and treatment planning.
311 services12 patients
Blood test, comprehensive group of blood chemicals 80053
A comprehensive group of blood chemicals test, also known as a comprehensive metabolic panel, is a blood test that measures your sugar level, electrolyte and fluid balance, kidney function, and liver function. This helps to check your body's overall health.
299 services154 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.
244 services161 patients
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.
115 services86 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 76104 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
$87.20 typical visit price
range $56.47 – $171.07
Typical copayment $21.80 (range $14.11 – $42.76)
Most-billed visit code 99203
Established Patient
$99.68 typical visit price
range $18.18 – $139.68
Typical copayment $24.92 (range $4.54 – $34.92)
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.

89.44/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality75.85
Promoting Interoperability100
Improvement Activities40

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.

Radiology (Radiation Oncology)
500 S HENDERSON ST STE 200
FORT WORTH, TX 76104
Nurse Practitioner (Family)
500 S HENDERSON ST STE 200
FORT WORTH, TX 76104
Internal Medicine (Hematology & Oncology)
500 S HENDERSON ST STE 200
FORT WORTH, TX 76104
Nurse Practitioner (Family)
500 S HENDERSON ST STE 200
FT WORTH, TX 76104
Nurse Practitioner (Family)
500 S HENDERSON ST STE 200
FORT WORTH, TX 76104
Radiology (Radiation Oncology)
500 S HENDERSON ST STE 200
FORT WORTH, TX 76104
Physician Assistant
500 S HENDERSON ST STE 200
FORT WORTH, TX 76104
Physician Assistant
500 S HENDERSON ST STE 200
FORT WORTH, TX 76104

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 Rafaella Wallace's NPI number?

The NPI number for Rafaella Wallace is 1821469107. It was assigned to this individual provider in the NPPES registry on October 13, 2015.

Where is Rafaella Wallace located?

Rafaella Wallace practices at 500 S Henderson St Ste 200, Fort Worth, TX 76104. The listed phone number is (817) 413-1500.

What is Rafaella Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

Is Rafaella Wallace enrolled in Medicare?

Yes. Rafaella Wallace 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 Rafaella Wallace accept?

Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and Ambetter from Superior HealthPlan and 8 other insurers list Rafaella 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 Rafaella Wallace was last updated on December 1, 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.