JEFFREY W WALLACE (PA-C) – Physician Assistant, NPI 1649479171
Physician Assistant
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Profile Insights
NPPES metrics only — not quality of care.
1,853 PHYSICIAN ASSISTANT in MO
Provider Addresses for JEFFREY W WALLACE (PA-C)
1601 WENTZVILLE PKWY STE 117
WENTZVILLE, MO 633853814
Phone: (636) 332-8477
Type: Location
112, Piper Hill Drive, Saint Peters, Saint Charles County, Missouri, 63376, United States
FIRST FLOOR
SAINT PETERS, MO 633761690
Phone: (636) 441-3444
Fax: (636) 441-9832
Type: Mailing
112 Piper Hill Dr
First Floor
Saint Peters, MO 633761690
Phone: (636) 441-3444
Fax: (636) 441-9832
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $46.
Total Amount is formed as General ($46) + Research ($0) + Ownership ($0) = $46.
Last reported payment date: 2024-09-23 • Largest payer in this snapshot: Organogenesis Inc. ($24).
Total Amount
$46
General + Research + Ownership
Payments
2
Total payment records
General Amount
$46
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-23
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Organogenesis Inc. | $24 |
| Elite Orthopedics, Llc | $22 |
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: 2013-07-29
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 |
|---|---|---|---|---|
| I20130729001001 | I | Physician Assistant | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 132 | 93 | $0 |
| 73630 | X-ray of foot, minimum of 3 views | 114 | 64 | $0 |
| 73610 | X-ray of ankle, minimum of 3 views | 94 | 55 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 33 | 31 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 29 | 29 | $0 |
Insurance plans in this area (ZIP 63385)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | MO | 20610 | Aspiration and/or injection of large joint or joint capsule | 40 | 22 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Diagnostic Radiology | MO | |
| - | MO | |
| Nurse Practitioner | MO | |
| Physician Assistant | MO | |
| - | MO | |
| Nurse Practitioner | MO | |
| - | MO | |
| - | MO | |
| - | MO | |
| Interventional Pain Management, Anesthesiology | MO |
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