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

Q: 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.

Q: What is Matthew 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 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.

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: August 23, 2026.

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

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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

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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

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.

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)