KEVIN PETER SCOTT WALLACE (MD) – Internal Medicine Physician, NPI 1255309258
Internal Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
21,558 INTERNAL MEDICINE in CA
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Provider Addresses for KEVIN PETER SCOTT WALLACE (MD)
Menlo Medical Clinic, 1300, Crane Street, Menlo Park, San Mateo County, California, 94025, United States
MENLO PARK, CA 940254283
Phone: (650) 498-6649
Fax: (650) 326-7931
Mailing address matches the actual address.
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: 2017-10-26
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 |
|---|---|---|---|---|
| I20171026000792 | I | Internal Medicine | CA | 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 | 459 | 215 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 152 | 80 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 132 | 108 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 100 | 100 | $0 |
| 0134A | Adm sarscv2 bvl 50mcg/.5ml a | 24 | 24 | $0 |
Insurance plans in this area (ZIP 94025)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| INTERNAL MEDICINE | NY | 90670 | Pneumococcal vaccine for injection into muscle | 19 | 19 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | CA | |
| - | CA | |
| - | CA | |
| E N D O C R I N O L O G Y | CA | |
| - | CA | |
| Family Practice | CA | |
| - | CA | |
| - | CA | |
| - | CA | |
| - | CA |
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