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MR. MATTHEW EVAN WALLACE NP
NPI 1881177806
Nurse Practitioner in San Diego, CA

Active since September 14, 2018PECOS EnrolledAccepts Medicare Assignment
200 W ARBOR DR, SAN DIEGO, CA 92103(619) 306-5855 Get Directions Write a Review

NPPES record last updated: December 10, 2018. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Dec 10, 2018, Sep 14, 2018 (2 updates tracked since 2018).

About Mr. Matthew Evan Wallace Np NPPES

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

MR. MATTHEW EVAN WALLACE NP (NPI 1881177806) is an individual nurse practitioner in San Diego, California, licensed in California (NP95010225) and active in the NPI registry since September 2018. He is enrolled in Medicare PECOS and is a graduate of Other (2018).

NPPES Registry Identity

NPI1881177806
Entity TypeIndividualMale
Primary Taxonomy363L00000X
Provider Legal NameMR. MATTHEW EVAN WALLACECredential: NP
Location Address200 W ARBOR DRSan Diego, CA 92103-9000
Mailing AddressPo Box 232410San Diego, CA 92193-2410
Phone(619) 306-5855
Sole ProprietorNo
Medical School CMSOtherGraduated 2018
Enumeration DateSeptember 14, 2018
Last NPPES UpdateDecember 10, 20182 updates tracked since enumeration
✔ NPI 1881177806 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 CA · NP95010225
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.
200 W ARBOR DR, San Diego, CA 92103
Open in Google Maps ↗

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

Mr. Matthew Evan Wallace Np 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 ID3274872635
PECOS Enrollment IDI20190228002445
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

3

Medicare enrollment records show Matthew Wallace reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Regents Of The University Of California
Same address
Surgery
200 W ARBOR DR
San Diego, CA 92103
  • Reassigned Medicare billing, California enrollment
  • 248 clinicians in this Medicare group
NPI 1740382993 (800) 926-8273
Reznik Medical Group
7.4 mi
Internal Medicine
220 E 24TH ST
National City, CA 91950
  • Reassigned Medicare billing, California enrollment
  • 7 clinicians in this Medicare group
NPI 1659873842 (619) 474-6741
Scripps Health Inpatient Providers Medical Group Inc.
9.8 mi
Multi-Specialty
9888 GENESEE AVE
La Jolla, CA 92037
  • Reassigned Medicare billing, California enrollment
  • 278 clinicians in this Medicare group
NPI 1699043000 (858) 626-4123

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 92103 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
$94.87 typical visit price
range $62.10 – $184.71
Typical copayment $23.71 (range $15.52 – $46.17)
Most-billed visit code 99203
Established Patient
$108.42 typical visit price
range $20.62 – $151.42
Typical copayment $27.10 (range $5.15 – $37.85)
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.

DR. RAMIN MOTARJEMI M.D.
Internal Medicine (Geriatric Medicine)
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (858) 249-2500
DR. KYLE PALMER EDMONDS M.D., FAAHPM
Hospice, Inpatient
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (800) 926-8273
SHAWN RAVEENTH VEDAMANI MD
Anesthesiology
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (800) 926-8273
DALE MICHAEL TRUJILLO NP
Nurse Practitioner
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (800) 926-8273
DR. EUGENE THOMAS RICHARDSON IV MD
Internal Medicine (Infectious Disease)
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (800) 926-8273
KAYLEE PETERSEN ARNP
Nurse Practitioner (Psychiatric/Mental Health)
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (800) 926-8273
IRENE NEVAREZ NP
Nurse Practitioner
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (800) 926-8273
WILLIAM JAMES MOSS M.D.
Student in an Organized Health Care Education/Training Program
200 W ARBOR DR
SAN DIEGO, CA 92103
San Diego County (508) 395-4189

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 Matthew Wallace's NPI number?

The NPI number for Matthew Wallace is 1881177806. It was assigned to this individual provider in the NPPES registry on September 14, 2018.

Where is Matthew Wallace located?

Matthew Wallace practices at 200 W Arbor Dr, San Diego, CA 92103. The listed phone number is (619) 306-5855.

What is Matthew Wallace's specialty?

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

Is Matthew Wallace enrolled in Medicare?

Yes. Matthew 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.

Which organizations bill Medicare for Matthew Wallace's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Matthew Wallace reassigns Medicare benefits to 3 organizations: Regents Of The University Of California (San Diego, CA), Reznik Medical Group (National City, CA) and Scripps Health Inpatient Providers Medical Group Inc. (La Jolla, CA). Each 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 Matthew 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 Matthew Wallace was last updated on December 10, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.