DR. CESALIE DEONNE WALLACE (APN) – Family Nurse Practitioner, NPI 1407104052
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,434 NURSE PRACTITIONER in AR
Provider Addresses for DR. CESALIE DEONNE WALLACE (APN)
3000 NORTH FIRST STREET
JACKSONVILLE, AR 72076
Phone: (501) 982-7477
Type: Location
3000 N 1ST ST
JACKSONVILLE, AR 720761802
Phone: (501) 982-7477
Type: Mailing
4301 W Markham St # 519
Little Rock, AR 722057101
Phone: (501) 686-7977
Fax: (501) 526-7522
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $105.
Total Amount is formed as General ($105) + Research ($0) + Ownership ($0) = $105.
Last reported payment date: 2024-11-07 • Largest payer in this snapshot: Novo Nordisk Inc ($105).
Total Amount
$105
General + Research + Ownership
Payments
1
Total payment records
General Amount
$105
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-07
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Novo Nordisk Inc | $105 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2014-03-17
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20140317000980 | I | Nurse Practitioner | AR | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 20 | 18 | $0 |
| 36415 | Insertion of needle into vein for collection of blood sample | 13 | 13 | $0 |
Insurance plans in this area (ZIP 72076)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| N E U R O L O G Y | AR | |
| - | AR | |
| Internal Medicine | NY | |
| Internal Medicine, Nephrology | AR | |
| Diagnostic Radiology | AR | |
| - | AR | |
| - | AR | |
| Nurse Practitioner | AR | |
| P S Y C H I A T R Y | AR | |
| - | AR |
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