LISA MARIE WALLACE (CRNA) – Certified Registered Nurse Anesthetist, NPI 1548439375

Certified Registered Nurse Anesthetist

LISA MARIE WALLACE (CRNA) is a healthcare provider. based in Macon, Georgia. specializing in CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA). They hold the professional credentials CRNA. They hold a License No. 1-097840 (AL). The NPI Number for LISA MARIE WALLACE (CRNA) is 1548439375

Main info

Female

19 Years Of Experience

Accepts Medicare Assignment

Name

LISA MARIE WALLACE (CRNA)

NPI

1548439375

Phone

(478) 633-6706

Address

598 3RD ST

Enumeration Date

26 February 2008

Last Update Date

5 June 2015

Doctor Profile

Medical School Name

OTHER

Secondary Phone

6785801349

Graduation Year

2007 (19 years ago)

PAC ID

0749366276

Group Practice PAC ID

8022300748

Professional Enrollment ID

I20080918000069

Address ID

AL363302510EN400XXSTXX400

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience50

Completeness75

Years active:18State licenses:1Digital endpointsOther names

1,710 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in GA

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Provider Addresses for LISA MARIE WALLACE (CRNA)

598, 3rd Street, Macon, Bibb County, Georgia, 31201, United States
MACON, GA 312013357
Phone: (478) 633-6706
Type: Mailing
Navicent Health, 777, Hemlock Street, Macon, Bibb County, Georgia, 31201, United States
MACON, GA 312012102
Phone: (478) 633-1000
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: 2008-09-18

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

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
I20080918000069	I	Certified Registered Nurse Anesthetist (Crna)	AL	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.

Verify on CMS Revalidation Lookup Tool

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 31201)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 8022300748View full group profile

Name	Specialty	State
ERIC ALEXANDER SWINFORD (CRNA)	Certified Registered Nurse Anesthetist (Crna)	AL
MR. BARRY T LEATH (CRNA)	-	GA
WILLIAM WADE SHARP (CRNA)	Certified Registered Nurse Anesthetist (Crna)	AL
JACK LEE SUDDRETH (CRNA)	-	GA
SCOTT JAY BULLARD (MD)	Anesthesiology, Pain Management	FL
STARLA K SHOUPE (CRNA)	-	AL
KARA MCANNALLY (CRNA)	Certified Registered Nurse Anesthetist (Crna)	AL
LORI JANEEN BRADLEY (CRNA)	Certified Registered Nurse Anesthetist (Crna)	AL
JOHN PELLICCIA (MD)	A N E S T H E S I O L O G Y	IN
MICHAEL RICHARD JR. STANLEY (CRNA)	Certified Registered Nurse Anesthetist (Crna)	AL

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Frequently asked questions

What number should I use to identify LISA MARIE WALLACE (CRNA) for billing?

Administrative and clinical systems typically use NPI 1548439375 for LISA MARIE WALLACE (CRNA).

Does the public listing show LISA MARIE WALLACE (CRNA) as active?

LISA MARIE WALLACE (CRNA)'s NPI record reflects an active status in NPPES.

Which specialty label fits LISA MARIE WALLACE (CRNA)?

NPPES ties LISA MARIE WALLACE (CRNA) to Certified Registered Nurse Anesthetist in the taxonomy section. Clinical services aligned with this taxonomy classification.

Which community is linked to LISA MARIE WALLACE (CRNA)?

LISA MARIE WALLACE (CRNA) shows a connection to Macon, Georgia in registry-derived data.

Who maintains LISA MARIE WALLACE (CRNA)'s record?

Providers certify NPPES data; CMS hosts the public file you are viewing.