Bradley Wallace, MD in Colorado Springs, CO

Bradley Wallace, MD is a medicare enrolled "Surgery" physician in Colorado Springs, Colorado. His current practice location is 1400 E Boulder St Ste 500, Colorado Springs, Colorado. You can reach out to his office (for appointments etc.) via phone at (719) 364-6487.

Bradley Wallace is licensed to practice in Colorado (license number DR.0063071) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1881038115.

Contact Information

	Bradley Wallace, MD
	1400 E Boulder St Ste 500, Colorado Springs, CO 80909-5533
	(719) 364-6487
	Not Available

Map and Direction

Physician's Profile

Full Name	Bradley Wallace
Gender	Male
Speciality	Surgery
Location	1400 E Boulder St Ste 500, Colorado Springs, Colorado
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1881038115
Provider Enumeration Date: 04/17/2013
Last Update Date: 06/23/2022

Medicare PECOS Information:

PECOS PAC ID: 3375854490
Enrollment ID: I20220922002158

Medical Identifiers

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

Identifier	Type	State	Issuer
1881038115	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
208600000X	Surgery	DR.0063071 (Colorado)	Primary
390200000X	Student In An Organized Health Care Education/training Program	(* (Not Available))	Secondary

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. Bradley Wallace allows following entities to bill medicare on his behalf.

Entity Name	Poudre Valley Medical Group Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1366763260 PECOS PAC ID: 9638208549 Enrollment ID: O20100602000122

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. Bradley 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
Bradley Wallace, MD 2695 Rocky Mountain Ave Ste 150, Loveland, CO 80538-9071 Ph: (719) 364-6487	Bradley Wallace, MD 1400 E Boulder St Ste 500, Colorado Springs, CO 80909-5533 Ph: (719) 364-6487

Reviews and Comments

Surgery Doctors in Colorado Springs, CO

Dr. Larry D Dillon, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 1715 N Weber St, Ste 330, Colorado Springs, CO 80907 Phone: 719-473-7400 Fax: 719-473-7408
Khurram Ahmad Khan, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 1633 Medical Center Point, Colorado Springs, CO 80907 Phone: 719-475-9800 Fax: 719-473-5436
Thomas J. Schroeppel, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 1400 E Boulder St, Suite 600, Colorado Springs, CO 80909 Phone: 719-364-6487 Fax: 719-364-6488
Dr. Amilu Rothhammer, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 1633 Medical Center Pt, Colorado Springs, CO 80907 Phone: 719-475-9800
Dr. Lisa Lynn Schlitzkus, Surgery Medicare: Accepting Medicare Assignments Practice Location: 1400 E Boulder St Ste 500, Colorado Springs, CO 80909 Phone: 719-364-6487
Gregory Carlson, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 1400 E Boulder St, Suite 600, Colorado Springs, CO 80909 Phone: 719-365-6487 Fax: 719-364-6488
Dr. John Lindley Frerichs, M.D. Surgery Medicare: Not Enrolled in Medicare Practice Location: 4925 N Nevada Ave, Room 416, Colorado Springs, CO 80918 Phone: 719-425-0933

Bradley Wallace, MD - Medicare Surgery in Colorado Springs, CO