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SARA S WALLIS AGACNP
NPI 1912760141
Nurse Practitioner - Acute Care in Decatur, IL

Active since January 31, 2024PECOS Enrolled
2300 N EDWARD ST, DECATUR, IL 62526(217) 876-4200(217) 876-4209 Get Directions Write a Review

NPPES record last updated: September 25, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Sara S Wallis Agacnp NPPES

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

SARA S WALLIS AGACNP (NPI 1912760141) is an individual acute care provider in Decatur, Illinois, licensed in Illinois (209029068) and active in the NPI registry since January 2024. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1912760141
Entity TypeIndividualFemale
Primary Taxonomy363LA2100X
Provider Legal NameSARA S WALLISCredential: AGACNP
Location Address2300 N EDWARD STDecatur, IL 62526-4163
Mailing Address2300 N Edward StDecatur, IL 62526-4163 · (217) 876-4200 · Fax (217) 876-4209
Phone(217) 876-4200
Fax(217) 876-4209
Sole ProprietorNo
Enumeration DateJanuary 31, 2024
Last NPPES UpdateSeptember 25, 2024
NPPES CertifiedSeptember 25, 2024
✔ NPI 1912760141 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
License✔ Licensed in IL · 209029068
2300 N EDWARD ST, Decatur, IL 62526
Open in Google Maps ↗

Other Identifiers 1

Other041462573IL · Rn License

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Sara S Wallis Agacnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Reassignment

Medicare enrollment records show Sara Wallis reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Decatur Memorial Hospital
Same address
General Acute Care Hospital
2300 N EDWARD ST, GSBLL
Decatur, IL 62526
  • Reassigned Medicare billing, Illinois enrollment
  • 166 clinicians in this Medicare group
NPI 1164477725 (217) 876-2868

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 62526 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
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$97.25 typical visit price
range $17.16 – $136.56
Typical copayment $24.31 (range $4.29 – $34.14)
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.

CULLEN WHICKER CRNA
Nurse Anesthetist, Certified Registered
2300 N EDWARD ST
DECATUR, IL 62526
Macon County (217) 876-2575
MR. JASON GRAUER APRN
Nurse Practitioner (Family)
2300 N EDWARD ST
DECATUR, IL 62526
Macon County (217) 876-8121
DR. JEFFREY MARC BOORSTEIN MD
Radiology (Diagnostic Radiology)
2300 N EDWARD ST
DECATUR, IL 62526
Macon County (217) 876-2300
PAUL GURLEY PA-C
Physician Assistant
2300 N EDWARD ST
DECATUR, IL 62526
Macon County (217) 876-3000
CHRISTINE W CUTLER MS RD LD/N
Dietitian, Registered
2300 N EDWARD ST
DECATUR, IL 62526
Macon County (217) 876-2281
JACLYN NICOLE KLEMAN
Physical Therapist
2300 N EDWARD ST
DECATUR, IL 62526
Macon County (217) 876-2600
BRITTNEY L JEFFERY CRNA
Nurse Anesthetist, Certified Registered
2300 N EDWARD ST
DECATUR, IL 62526
Macon County (217) 876-2275
DR. DAVID JOSEPH EVELTI MD
Anesthesiology
2300 N EDWARD ST
DECATUR, IL 62526
Macon County (217) 876-8121

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 Sara Wallis's NPI number?

The NPI number for Sara Wallis is 1912760141. It was assigned to this individual provider in the NPPES registry on January 31, 2024.

Where is Sara Wallis located?

Sara Wallis practices at 2300 N Edward St, Decatur, IL 62526. The listed phone number is (217) 876-4200.

What is Sara Wallis's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Is Sara Wallis enrolled in Medicare?

Yes. Sara Wallis is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Sara Wallis's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Sara Wallis reassigns Medicare benefits to Decatur Memorial Hospital (Decatur, IL). The 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 Sara Wallis'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 Sara Wallis was last updated on September 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.