Mrs Cynthia Wallace, AGPCNP - Medicare Nurse Practitioner in Medford, OR

Mrs Cynthia Wallace, AGPCNP is a medicare enrolled "Nurse Practitioner - Gerontology" in Medford, Oregon. She graduated from nursing school in 2014 and has 10 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Providence Health And Services Oregon and her current practice location is 1111 Crater Lake Ave, Medford, Oregon. You can reach out to her office (for appointments etc.) via phone at (541) 732-5250.

Mrs Cynthia Wallace is licensed to practice in Oregon (license number 201500016NP-PP) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1811393648.

Contact Information

Mrs Cynthia Wallace, AGPCNP
1111 Crater Lake Ave,
Medford, OR 97504-6241
(541) 732-5250
(541) 732-5251

Map and Direction




Provider's Profile

Full NameMrs Cynthia Wallace
GenderFemale
SpecialityNurse Practitioner
Experience10 Years
Location1111 Crater Lake Ave, Medford, Oregon
Accepts Medicare AssignmentsYes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Mrs Cynthia Wallace graduated from nursing school in 2014
  NPI Data:
  • NPI Number: 1811393648
  • Provider Enumeration Date: 11/05/2014
  • Last Update Date: 09/30/2020
  Medicare PECOS Information:
  • PECOS PAC ID: 7911219035
  • Enrollment ID: I20150702000790

Medical Identifiers

Medical identifiers for Mrs Cynthia Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1811393648NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LG0600XNurse Practitioner - Gerontology 201500016NP-PP (Oregon)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Providence Medford Medical CenterMedford, ORHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Providence Health And Services Oregon630575500020

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. Mrs Cynthia Wallace allows following entities to bill medicare on her behalf.
Entity NameProvidence Health & Services Oregon
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1093976243
PECOS PAC ID: 3476450560
Enrollment ID: O20031217000186
Entity NameProvidence Health & Services Oregon
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1043366172
PECOS PAC ID: 6305755000
Enrollment ID: O20040126000526

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. Mrs Cynthia 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
Mrs Cynthia Wallace, AGPCNP
Po Box 3308,
Portland, OR 97208-3308

Ph: (541) 732-5250
Mrs Cynthia Wallace, AGPCNP
1111 Crater Lake Ave,
Medford, OR 97504-6241

Ph: (541) 732-5250

Reviews and Comments


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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.