PHILLIP TYLER WALLACE APRN
NPI 1821647447
Nurse Practitioner in Jacksonville, FL

Q: What is Phillip Wallace's NPI number?

The NPI number for Phillip Wallace is 1821647447. It was assigned to this individual provider in the NPPES registry on September 6, 2019.

Q: What is Phillip Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Phillip Wallace was last updated on June 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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 September 06, 2019PECOS EnrolledAccepts Medicare Assignment

84.38/100

CMS Quality Rating

4500 SAN PABLO RD S, JACKSONVILLE, FL 32224(904) 953-2000 Get Directions Write a Review

NPPES record last updated: June 10, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Apr 14, 2026, Mar 24, 2026, Sep 19, 2022 and 1 more (4 updates tracked since 2019).

On this page

About Phillip Tyler Wallace Aprn NPPES

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

PHILLIP TYLER WALLACE APRN (NPI 1821647447) is an individual nurse practitioner in Jacksonville, Florida, licensed in Florida (APRN11003275) and active in the NPI registry since September 2019. He is enrolled in Medicare PECOS, is affiliated with Mayo Clinic, and maintains a secondary practice location in Jacksonville.

NPPES Registry Identity

NPI1821647447

Entity TypeIndividualMale

Primary Taxonomy363L00000X

Provider Legal NamePHILLIP TYLER WALLACECredential: APRN

Location Address4500 SAN PABLO RD SJacksonville, FL 32224-1865

Mailing AddressPo Box 860912Minneapolis, MN 55486-0912 · Fax (904) 253-6964

Phone(904) 953-2000

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateSeptember 6, 2019

Last NPPES UpdateJune 10, 20264 updates tracked since enumeration

NPPES CertifiedJune 10, 2026

✔ NPI 1821647447 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in FL · APRN11003275

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

4500 SAN PABLO RD S, Jacksonville, FL 32224

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Secondary Practice Location 1

Location 11325 San Marco Blvd Ste 300Jacksonville, FL 32207-8567 · Phone (904) 253-6910 · Fax (904) 253-6964

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Phillip Tyler Wallace Aprn 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 ID2961734421

PECOS Enrollment IDI20191101001897

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 Reassignments

Medicare enrollment records show Phillip Wallace reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Mayo Clinic Jacksonville

Same address

Health Service

4500 SAN PABLO RD S
Jacksonville, FL 32224

Reassigned Medicare billing, Florida enrollment
1,828 clinicians in this Medicare group

NPI 1174143986 (904) 953-2000

Respiratory Critical Care And Sleep Medicine Associates,inc

13 mi

Pulmonary Disease

1443 SAN MARCO BLVD STE 101
Jacksonville, FL 32207

Reassigned Medicare billing, Florida enrollment
62 clinicians in this Medicare group

NPI 1386622629 (904) 253-6910

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 6

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.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233

Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.

335 services155 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

45 services35 patients

Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223

Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.

42 services41 patients

Critical care, first 30-74 minutes 99291

Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.

37 services36 patients

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

33 services33 patients

Insertion of artery tube for blood sampling or infusion through skin 36620

This procedure involves placing a small tube into an artery, usually in the wrist or elbow, to collect blood samples or administer medication. It's done under local anesthesia and is a common, safe practice.

12 services12 patients

Hospital Affiliations CMS Care Compare

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

Mayo Clinic

Acute Care Hospitals · Jacksonville, FL

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number100151

Location4500 San Pablo RdJacksonville, FL 32224 · Duval County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32224 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

$87.62 typical visit price

range $56.00 – $171.84

Typical copayment $21.90 (range $14.00 – $42.96)

Most-billed visit code 99203

Established Patient

$99.16 typical visit price

range $17.57 – $139.16

Typical copayment $24.79 (range $4.39 – $34.79)

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.

84.38/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

71.4

Promoting Interoperability

Improvement Activities

Cost

72.34

Referred Medical Equipment & Supplies CMS DME claims

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

Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) E0466

DME-Other DME · category DE005N

1 supplier12 claims12 services$907.03 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 20

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

KATHERINE L WALSH PA-C/MPH

Physician Assistant