MS. DONETTA WALLACE (P.A.-C) – Physician Assistant, NPI 1417958828
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,728 PHYSICIAN ASSISTANT in KY
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Provider Addresses for MS. DONETTA WALLACE (P.A.-C)
PO BOX 2709
PAINTSVILLE, KY 412406709
Phone: (606) 789-8666
Fax: (606) 788-0253
Type: Mailing
PO BOX 2379
ASHLAND, KY 411052379
Phone: (606) 408-9571
Fax: (606) 408-6061
Type: Mailing
North Mayo Trail, Paintsville, Johnson County, Kentucky, 41240, United States
PAINTSVILLE, KY 412401804
Phone: (606) 789-8666
Fax: (606) 788-0253
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 237 Open Payments records for all available years, with a total value of $3,983.
Total Amount is formed as General ($3,983) + Research ($0) + Ownership ($0) = $3,983.
Last reported payment date: 2024-12-19 • Largest payer in this snapshot: ABBVIE INC. ($706).
Total Amount
$3,983
General + Research + Ownership
Payments
237
Total payment records
General Amount
$3,983
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-19
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $706 |
| GlaxoSmithKline, LLC. | $544 |
| Novo Nordisk Inc | $498 |
| PFIZER INC. | $403 |
| Amgen Inc. | $206 |
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: 2004-02-26
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 |
|---|---|---|---|---|
| I20040226000281 | I | Physician Assistant | KY | 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 | 634 | 144 | $0 |
| 36415 | Insertion of needle into vein for collection of blood sample | 285 | 126 | $0 |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 196 | 26 | $0 |
| 96372 | Injection of drug or substance under skin or into muscle | 111 | 49 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 89 | 64 | $0 |
Insurance plans in this area (ZIP 41240)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | KY | 81002 | Urinalysis, manual test | 29 | 29 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OH | |
| Nurse Practitioner | KY | |
| Nurse Practitioner | KY | |
| Clinical Social Worker | KY | |
| - | KY | |
| Nurse Practitioner | KY | |
| Nurse Practitioner | KY | |
| - | OH | |
| Family Practice | KY | |
| Nurse Practitioner | WV |
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