Amy Jo Wallace, MD in Kernersville, NC

Amy Jo Wallace, MD is a medicare enrolled "Pediatrics" physician in Kernersville, North Carolina. Her current practice location is 861 Old Winston Rd Ste 101, Kernersville, North Carolina. You can reach out to her office (for appointments etc.) via phone at (336) 904-0143.

Amy Jo Wallace is licensed to practice in North Carolina (license number 200600865) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1467487322.

Contact Information

	Amy Jo Wallace, MD
	861 Old Winston Rd Ste 101, Kernersville, NC 27284-7141
	(336) 904-0143
	(336) 904-0046

Map and Direction

Physician's Profile

Full Name	Amy Jo Wallace
Gender	Female
Speciality	Pediatrics
Location	861 Old Winston Rd Ste 101, Kernersville, North Carolina
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1467487322
Provider Enumeration Date: 07/11/2006
Last Update Date: 11/04/2020

Medicare PECOS Information:

PECOS PAC ID: 0446485288
Enrollment ID: I20131101000297

Medical Identifiers

Medical identifiers for Amy Jo Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1467487322	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
208000000X	Pediatrics	26169 (South Carolina)	Secondary
208000000X	Pediatrics	200600865 (North Carolina)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Amy Jo Wallace allows following entities to bill medicare on her behalf.

Entity Name	Wake Forest University Health Sciences
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1003803032 PECOS PAC ID: 4486564952 Enrollment ID: O20031105000436

Entity Name	Wake Forest Health Network Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1477785756 PECOS PAC ID: 4183538895 Enrollment ID: O20031117000868

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Amy Jo Wallace is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Amy Jo Wallace, MD Po Box 602658, Charlotte, NC 28260-2658 Ph: (336) 716-2011	Amy Jo Wallace, MD 861 Old Winston Rd Ste 101, Kernersville, NC 27284-7141 Ph: (336) 904-0143

Reviews and Comments

Pediatrics Doctors in Kernersville, NC

Rebecca P Ball, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 861 Old Winston Rd Ste 101, Kernersville, NC 27284 Phone: 336-904-0143 Fax: 336-904-0046
George Kirk Walker, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 240 Broad St, Kernersville, NC 27284 Phone: 336-993-8333 Fax: 336-993-5144
Leslie Rierson Smith, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 861old Winston Road, Suite 103, Kernersville, NC 27284 Phone: 336-802-2300 Fax: 336-802-2301
Shelley Rickman, PA-C Pediatrics Medicare: Medicare Enrolled Practice Location: 861 Old Winston Rd Ste 103, Kernersville, NC 27284 Phone: 336-802-2300
Kristin Lynn Dickson, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 111 Gateway Center Drive, Kernersville, NC 27284 Phone: 336-996-9500 Fax: 336-996-2354
Cathy Marie Soldato-couture, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 240 Broad St, Kernersville, NC 27284 Phone: 336-993-8333 Fax: 336-993-5144

Amy Jo Wallace, MD - Medicare Pediatrics in Kernersville, NC