CHERRY WALLACE – Gerontology Nurse Practitioner, NPI 1013886456
Gerontology Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
7,017 NURSE PRACTITIONER in MO
Provider Addresses for CHERRY WALLACE
905 CHESTNUT RIDGE RD
MANCHESTER, MO 630216925
Phone: (314) 536-1897
Fax: (314) 536-1897
Type: Mailing
425 N NEW BALLAS RD STE 203
SAINT LOUIS, MO 631416848
Phone: (314) 872-3104
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: 2025-11-20
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 |
|---|---|---|---|---|
| I20251120001366 | I | Nurse Practitioner | MO | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 63021)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Orthopedic Surgery | MO | |
| Orthopedic Surgery, Hand Surgery | NY | |
| Physical Medicine And Rehabilitation | MO | |
| Physical Therapist In Private Practice | MO | |
| Orthopedic Surgery | MO | |
| Nurse Practitioner | MO | |
| Nurse Practitioner | MO | |
| - | MO | |
| Physical Therapist In Private Practice | MO | |
| A L L E R G Y/ I M M U N O L O G Y | MO |
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