DR. WALLACE M ANDERSON (MD) – Diagnostic Radiology Physician, NPI 1578510913
Diagnostic Radiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,121 DIAGNOSTIC RADIOLOGY in IL
Provider Addresses for DR. WALLACE M ANDERSON (MD)
PO BOX 662
EDWARDSVILLE, IL 620250662
Phone: (877) 833-5034
Fax: (405) 948-6507
Type: Mailing
4500 Memorial Dr
Dept Radiology
Belleville, IL 622265360
Phone: (618) 257-9567
Type: Location
111 OAKWOOD RD
EAST PEORIA, IL 616111853
Phone: (309) 740-4272
Type: Mailing
800 E CARPENTER ST
SPRINGFIELD, IL 627695360
Phone: (217) 544-6464
Type: Location
Memorial Hospital, 4500, Memorial Drive, Royal Heights, Belleville, Saint Clair County, Illinois, 62226, United States
DEPT RADIOLOGY
BELLEVILLE, IL 622265360
Phone: (618) 257-9567
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: 2004-04-29
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 |
|---|---|---|---|---|
| I20040429000122 | I | Diagnostic Radiology | 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 |
|---|---|---|---|---|
| 77067 | Screening mammography | 746 | 746 | $0 |
| 77063 | Screening 3d breast mammography | 743 | 743 | $0 |
| 71045 | X-ray of chest, 1 view | 276 | 259 | $0 |
| 71046 | X-ray of chest, 2 views | 247 | 237 | $0 |
| 70450 | Ct scan head or brain without contrast | 186 | 180 | $0 |
Insurance plans in this area (ZIP 62025)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DIAGNOSTIC RADIOLOGY | IL | 71010 | X-ray of chest, 1 view, front | 502 | 442 |
| DIAGNOSTIC RADIOLOGY | IL | 73562 | X-ray of knee, 3 views | 112 | 76 |
| DIAGNOSTIC RADIOLOGY | IL | 93971 | Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers | 43 | 42 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Diagnostic Radiology | FL | |
| Diagnostic Radiology | IL | |
| Physician Assistant | IL | |
| - | IL | |
| Diagnostic Radiology | FL | |
| - | IL | |
| Diagnostic Radiology | IL | |
| - | IL | |
| - | IL | |
| Diagnostic Radiology | IL |
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