Kimberly Lane Wallace, NP-C - Medicare Nurse Practitioner in Beavercreek, OH

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Kimberly Lane Wallace, NP-C is a medicare enrolled "Nurse Practitioner - Primary Care" in Beavercreek, Ohio. Her current practice location is 3535 Pentagon Blvd, Beavercreek, Ohio. You can reach out to her office (for appointments etc.) via phone at (937) 702-4000.

Kimberly Lane Wallace is licensed to practice in Ohio (license number APRN.CNP.0032777) 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 1619688116.

Contact Information

Kimberly Lane Wallace, NP-C
3535 Pentagon Blvd,
Beavercreek, OH 45431-1705
(937) 702-4000
Not Available

Map and Direction




Provider's Profile

Full NameKimberly Lane Wallace
GenderFemale
SpecialityNurse Practitioner - Primary Care
Location3535 Pentagon Blvd, Beavercreek, Ohio
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1619688116
  • Provider Enumeration Date: 12/06/2022
  • Last Update Date: 12/06/2022
  Medicare PECOS Information:
  • PECOS PAC ID: 9739550666
  • Enrollment ID: I20230131003264

Medical Identifiers

Medical identifiers for Kimberly Lane Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1619688116NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LP2300XNurse Practitioner - Primary Care APRN.CNP.0032777 (Ohio)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. Kimberly Lane Wallace allows following entities to bill medicare on her behalf.
Entity NameNephrology Associates Of Dayton Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1184698458
PECOS PAC ID: 1850380601
Enrollment ID: O20040507000974

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. Kimberly Lane 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 AddressPractice Location Address
Kimberly Lane Wallace, NP-C
935 Salem St,
Brookville, OH 45309-8225

Ph: (937) 344-5173		Kimberly Lane Wallace, NP-C
3535 Pentagon Blvd,
Beavercreek, OH 45431-1705

Ph: (937) 702-4000

Reviews and Comments


Nurse Practitioner Nurses in Beavercreek, OH

Carrie Steward, APRN-CNP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 2605 Greenbrier Ct, Beavercreek, OH 45431
Phone: 937-782-8103    
Jessica Lynn Ullery, CNP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 3535 Pentagon Blvd Ste 220, Beavercreek, OH 45431
Phone: 937-429-7350    Fax: 937-431-2623
Mrs. Theresa Marie Borchers, C.R.N.P.
Nurse Practitioner
Medicare: Not Enrolled in Medicare
Practice Location: 1331 N Fairfield Rd, Beavercreek, OH 45432
Phone: 937-426-4280    
Laura Busteed,
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 3535 Pentagon Blvd Ste 320, Beavercreek, OH 45431
Phone: 937-490-2270    
Sheryl Spires, NP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 2510 Commons Blvd, Suite 210, Beavercreek, OH 45431
Phone: 937-429-0607    Fax: 937-558-3067
Gregory David Bellanca, NP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 725 University Blvd, Beavercreek, OH 45324
Phone: 937-245-7200    Fax: 937-245-7999
Yolonda M Kelly, NP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 2510 Commons Blvd. Suite 160, Beavercreek, OH 45431
Phone: 937-426-0049    Fax: 937-431-8140

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.