DR. GRAHAM WILSON WALLACE (MD) – Diagnostic Radiology Physician, NPI 1063499267
Diagnostic Radiology Physician
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Profile Insights
NPPES metrics only — not quality of care.
4,800 DIAGNOSTIC RADIOLOGY in CA
Provider Addresses for DR. GRAHAM WILSON WALLACE (MD)
DAVID GRANT MEDICAL CENTER
101 BODIN CIRCLE
TRAVIS AFB, CA 945351809
Phone: (707) 423-3040
Type: Mailing
University of California San Francisco
505 Parnassus Ave.
San Francisco, CA 94143
Phone: (415) 885-7268
Fax: (415) 885-7445
Type: Location
Kaiser Permanente
4601 Dale Rd.
Modesto, CA 95356
Phone: (209) 735-3290
Fax: (877) 516-6086
Type: Location
David Grant Medical Center
101 Bodin Circle
Travis AFB, CA 945351809
Phone: (707) 423-3040
Type: Location
777 BANNOCK ST
DENVER, CO 802044597
Phone: (303) 643-6494
Fax: (303) 602-4168
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2026-01-20
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20220906003401 | I | Diagnostic Radiology | CO | TBD |
| I20260120000068 | I | Diagnostic Radiology | NY | 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 |
|---|---|---|---|---|
| 71045 | X-ray of chest, 1 view | 144 | 107 | $0 |
| 71046 | X-ray of chest, 2 views | 104 | 102 | $0 |
| 71250 | Ct scan of chest without contrast | 89 | 81 | $0 |
| 74177 | Ct scan of abdomen and pelvis with contrast | 72 | 68 | $0 |
| 71260 | Ct scan of chest with contrast | 62 | 56 | $0 |
Insurance plans in this area (ZIP 94535)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | PA | |
| O B S T E T R I C S/ G Y N E C O L O G Y | NY | |
| Internal Medicine | NY | |
| - | NY | |
| A N E S T H E S I O L O G Y | TX | |
| Physical Therapist In Private Practice | NY | |
| A N E S T H E S I O L O G Y | NY | |
| - | NY | |
| - | NY | |
| - | NY |
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