DR. RYAN MYLES WALLACE – Addiction Medicine (Preventive Medicine) Physician, NPI 1548695075
Addiction Medicine (Preventive Medicine) Physician
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Profile Insights
NPPES metrics only — not quality of care.
851 PSYCHIATRY in CT
Provider Addresses for DR. RYAN MYLES WALLACE
1 LONG WHARF DR STE 321
NEW HAVEN, CT 065115946
Phone: (203) 781-4600
Fax: (203) 781-4624
Type: Mailing
55 LOCK ST
NEW HAVEN, CT 06511
Phone: (203) 432-0290
Type: Location
1201 E 36th Ave
Anchorage, AK 995084372
Phone: (907) 562-9229
Fax: (907) 562-1603
Type: Location
365 Montauk Ave
New London, CT 063204700
Phone: (860) 442-0711
Type: Location
55 Lock St
New Haven, CT 06511
Phone: (203) 432-0290
Type: Location
PO BOX 31001-4162
PASADENA, CA 911104162
Phone: (866) 747-2455
Type: Mailing
3760 PIPER ST STE 1108
ANCHORAGE, AK 995084683
Phone: (907) 212-6900
Fax: (907) 212-6936
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 5 Open Payments records for all available years, with a total value of $351.
Total Amount is formed as General ($351) + Research ($0) + Ownership ($0) = $351.
Last reported payment date: 2024-11-20 • Largest payer in this snapshot: Abbott Laboratories ($306).
Total Amount
$351
General + Research + Ownership
Payments
5
Total payment records
General Amount
$351
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-20
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Abbott Laboratories | $306 |
| Inari Medical, Inc. | $45 |
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: 2020-09-17
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 |
|---|---|---|---|---|
| I20200917000602 | I | Psychiatry | AK | 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 06511)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | AK | |
| - | AK | |
| Family Practice | OR | |
| Cardiovascular Disease (Cardiology) | AK | |
| Cardiovascular Disease (Cardiology), Internal Medicine | AK | |
| Cardiovascular Disease (Cardiology) | AK | |
| Nurse Practitioner | AK | |
| - | AK | |
| Peripheral Vascular Disease, Cardiovascular Disease (Cardiology), Interventional Cardiology | AK | |
| - | AK |
Reviews
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