Kisha Wallace, in New York, NY - Medicare Nurse Practitioner

Kisha Wallace, is a medicare enrolled "Nurse Practitioner - Adult Health" in New York, New York. Her current practice location is 1 Gustave L Levy Pl, New York, New York. You can reach out to her office (for appointments etc.) via phone at (212) 241-6500.

Kisha Wallace is licensed to practice in New York (license number F308252) 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 1417433939.

Contact Information

	Kisha Wallace,
	1 Gustave L Levy Pl, New York, NY 10029-6504
	(212) 241-6500
	(212) 426-5040

Map and Direction

Provider's Profile

Full Name	Kisha Wallace
Gender	Female
Speciality	Nurse Practitioner - Adult Health
Location	1 Gustave L Levy Pl, New York, New York
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1417433939
Provider Enumeration Date: 07/17/2018
Last Update Date: 06/09/2021

Medicare PECOS Information:

PECOS PAC ID: 0941609143
Enrollment ID: I20210520000345

Medical Identifiers

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

Identifier	Type	State	Issuer
1417433939	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LA2200X	Nurse Practitioner - Adult Health	F308252 (New York)	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. Kisha Wallace allows following entities to bill medicare on her behalf.

Entity Name	Icahn School Of Medicine At Mount Sinai
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1689947160 PECOS PAC ID: 2264691070 Enrollment ID: O20120720000202

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. Kisha 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
Kisha Wallace, 150 E 42nd St # 3000, New York, NY 10017-5612 Ph: (646) 605-8119	Kisha Wallace, 1 Gustave L Levy Pl, New York, NY 10029-6504 Ph: (212) 241-6500

Reviews and Comments

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Kisha Wallace, - Medicare Nurse Practitioner in New York, NY