MIATA WALLACE (PA) – Physician Assistant, NPI 1013656990

MIATA WALLACE (PA) is a healthcare provider. based in Lincoln, Nebraska. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA. They hold a License No. 2760 (NE). The NPI Number for MIATA WALLACE (PA) is 1013656990

Main info

Female
4 Years Of Experience
Accepts Medicare Assignment
Name
MIATA WALLACE (PA)
NPI
1013656990
Phone
(402) 483-8600
Address
1500 S 58TH ST STE 800
Enumeration Date
31 May 2022
Last Update Date
25 March 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4024133000
Graduation Year
2022 (4 years ago)
PAC ID
1456730126
Group Practice PAC ID
3072412881
Professional Enrollment ID
I20220627002051
Address ID
NE685062150LI5401XSTXX300

Contacts

Secure Messaging
miata.wallace.1@32348.direct.athenahealth.com
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness85
Years active:4State licenses:1Other namesUpdated within 12 months

1,396 PHYSICIAN ASSISTANT in NE

Provider Addresses for MIATA WALLACE (PA)

  • 1500 S 58TH ST STE 800

    LINCOLN, NE 685061407

    Phone: (402) 483-8600

    Fax: (402) 483-8689

    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 39 Open Payments records for all available years, with a total value of $819.

Total Amount is formed as General ($819) + Research ($0) + Ownership ($0) = $819.

Last reported payment date: 2024-12-16 • Largest payer in this snapshot: HARMONY BIOSCIENCES LLC ($137).

Total Amount

$819

General + Research + Ownership

Payments

39

Total payment records

General Amount

$819

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-16

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

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: 2022-06-27

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20220627002051IPhysician AssistantNETBD

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.

Verify on CMS Revalidation Lookup Tool

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes345286$0
99213Established patient office or other outpatient visit, 20-29 minutes3232$0
99215Established patient office or other outpatient visit, 40-54 minutes1313$0
View full utilization report →

Insurance plans in this area (ZIP 68506)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3072412881View full group profile
NameSpecialtyState
Critical Care (Intensivists), Sleep Medicine, Internal Medicine, Pulmonary DiseaseNE
Physician AssistantNE
Pulmonary DiseaseNE
Pulmonary Disease, Sleep MedicineNE
Nurse PractitionerNE
Pulmonary Disease, Critical Care (Intensivists), Internal MedicineNE
Nurse PractitionerNE
Physician AssistantNE
Physician AssistantNE
Nurse PractitionerNE

Reviews

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No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

What is the registry number for MIATA WALLACE (PA)?
The registry entry for MIATA WALLACE (PA) shows NPI 1013656990.
Is MIATA WALLACE (PA)'s NPI status active today?
Active status means MIATA WALLACE (PA)'s NPI record is not deactivated in the public file.
What type of care does MIATA WALLACE (PA) provide?
MIATA WALLACE (PA)'s profile centers on Physician Assistant. Clinical services aligned with this taxonomy classification.
Is MIATA WALLACE (PA) tied to Lincoln, Nebraska?
If you are local to Lincoln, Nebraska, MIATA WALLACE (PA) may be relevant to your search.
Can I export MIATA WALLACE (PA)'s record?
You can download the official NPPES record; we summarize key fields for readability.

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