DR. KEVIN R WALLACE (DMD) – General Practice Dentistry, NPI 1053423285
General Practice Dentistry
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
56 ORAL SURGERY in IL
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Provider Addresses for DR. KEVIN R WALLACE (DMD)
7501, Lemont Road, Downers Grove, DuPage County, Illinois, 60517, United States
STE 300
WOODRIDGE, IL 605172653
Phone: (630) 324-5370
Fax: (815) 744-7059
Type: Mailing
14831 W 159TH ST STE 1
LOCKPORT, IL 604919008
Phone: (630) 324-5369
Fax: (815) 744-7059
Type: Mailing
150, East Huron Street, Magnificent Mile, Near North Side, Chicago, Cook County, Illinois, 60611, United States
STE 1103
CHICAGO, IL 60611
Phone: (312) 676-9893
Fax: (815) 744-7059
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: 2016-06-20
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 |
|---|---|---|---|---|
| I20160620000860 | I | Oral Surgery | IL | 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 |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 322 | 261 | $0 |
| 70486 | Ct scan of face without contrast | 142 | 142 | $0 |
| 70350 | Imaging of jaws and skull | 142 | 142 | $0 |
| 70355 | X-ray of lower jaws, upper jaws and teeth | 140 | 140 | $0 |
| 99202 | New patient office or other outpatient visit, 15-29 minutes | 118 | 118 | $0 |
Insurance plans in this area (ZIP 60517)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| D E N T I S T | IL | |
| - | IL | |
| D E N T I S T | IL | |
| D E N T I S T | IL |
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