COLLEEN RAE WALLIS (P.A.C.) – Physician Assistant, NPI 1922066117
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,032 PHYSICIAN ASSISTANT in MN
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Provider Addresses for COLLEEN RAE WALLIS (P.A.C.)
3605, Mayfair Avenue, Hibbing, Saint Louis County, Minnesota, 55746, United States
HIBBING, MN 557462923
Phone: (218) 262-3441
Fax: (218) 362-6989
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $51.
Total Amount is formed as General ($51) + Research ($0) + Ownership ($0) = $51.
Last reported payment date: 2024-05-13 • Largest payer in this snapshot: Novartis Pharmaceuticals Corporation ($37).
Total Amount
$51
General + Research + Ownership
Payments
3
Total payment records
General Amount
$51
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-05-13
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Novartis Pharmaceuticals Corporation | $37 |
| Novo Nordisk Inc | $14 |
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: 2004-07-13
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 |
|---|---|---|---|---|
| I20040713001279 | I | Physician Assistant | MN | 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 | 106 | 63 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 55 | 42 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 19 | 19 | $0 |
Insurance plans in this area (ZIP 55746)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| General Surgery | WI | |
| - | MN | |
| Family Practice, Emergency Medicine | MN | |
| - | MN | |
| Nurse Practitioner | MN | |
| - | AL | |
| P A T H O L O G Y | ND | |
| - | CA | |
| - | MN | |
| - | OK |
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