SUSAN L. WALLACE (MD) – Psychiatry Physician, NPI 1255402160
Psychiatry Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,134 PSYCHIATRY in CA
Provider Addresses for SUSAN L. WALLACE (MD)
5730 Packard Ave Ste 500
Marysville, CA 959017119
Phone: (530) 749-3242
Fax: (530) 749-3248
Type: Location
3810 Rosin Ct Ste 100
Sacramento, CA 958341657
Phone: (530) 749-3242
Fax: (530) 749-3248
Type: Location
1275 Tharp Rd
Yuba City, CA 959932645
Phone: (530) 749-3242
Fax: (530) 749-3248
Type: Location
13652, Cantara Street, Panorama City, Los Angeles, Los Angeles County, California, 91402, United States
PANORAMA CITY, CA 914025423
Phone: (818) 375-2000
Type: Location
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: 2011-11-09
PECOS data refreshed: 2026-05-27
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 |
|---|---|---|---|---|
| I20111109000292 | I | Psychiatry | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 95901)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | CA | |
| - | CA | |
| - | CA | |
| Family Practice | MS | |
| Nurse Practitioner | CA | |
| Internal Medicine | CA | |
| Internal Medicine | CA | |
| - | CA | |
| Internal Medicine, Endocrinology | CA | |
| - | CA |
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