DR. TASHA B WALLACE (D.O.) – Family Medicine Physician, NPI 1396736997
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
6,722 FAMILY PRACTICE in FL
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Provider Addresses for DR. TASHA B WALLACE (D.O.)
3400, Lee Boulevard, Lehigh Acres, Fort Myers, Lee County, Florida, 33971, United States
SUITE 108
LEHIGH ACRES, FL 339711309
Phone: (239) 369-2903
Fax: (239) 369-0500
Type: Mailing
14651 PALM BEACH BLVD STE 100
FORT MYERS, FL 339052331
Phone: (239) 369-2903
Fax: (239) 369-0500
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: 2007-03-17
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 |
|---|---|---|---|---|
| I20070317000058 | I | Family Practice | FL | 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 | 779 | 327 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 317 | 190 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 201 | 201 | $0 |
| G0008 | Administration of influenza virus vaccine | 86 | 84 | $0 |
| 90694 | Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage | 77 | 77 | $0 |
Insurance plans in this area (ZIP 33971)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| FAMILY MEDICINE | FL | 81002 | Urinalysis, manual test | 39 | 32 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | VA | |
| - | NY | |
| Nurse Practitioner | MI | |
| Family Practice | TX | |
| Physician Assistant | NC | |
| Internal Medicine, Geriatric Medicine | NC | |
| Qualified Speech Language Pathologist | OK | |
| Occupational Therapist In Private Practice | NC | |
| Internal Medicine | NC | |
| Internal Medicine | NC |
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