MRS. PHYLLIS A WALLACE (APRN) – Family Nurse Practitioner, NPI 1366486417
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,299 NURSE PRACTITIONER in OK
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Provider Addresses for MRS. PHYLLIS A WALLACE (APRN)
527, West 3rd Street, Konawa, Seminole County, Oklahoma, 74849, United States
KONAWA, OK 748491415
Phone: (580) 925-3286
Fax: (580) 925-9149
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 2 Open Payments records for all available years, with a total value of $38.
Total Amount is formed as General ($38) + Research ($0) + Ownership ($0) = $38.
Last reported payment date: 2024-01-23 • Largest payer in this snapshot: ABBVIE INC. ($38).
Total Amount
$38
General + Research + Ownership
Payments
2
Total payment records
General Amount
$38
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-01-23
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $38 |
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: 2009-12-05
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 |
|---|---|---|---|---|
| I20091205000121 | I | Nurse Practitioner | OK | 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 |
|---|---|---|---|---|
| 80053 | Blood test, comprehensive group of blood chemicals | 55 | 46 | $0 |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 53 | 47 | $0 |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 32 | 28 | $0 |
| 83036 | Hemoglobin a1c level | 23 | 12 | $0 |
| 96372 | Injection of drug or substance under skin or into muscle | 17 | 15 | $0 |
Insurance plans in this area (ZIP 74849)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| NURSE PRACTITIONER | OK | 83036 | Hemoglobin A1C level | 32 | 20 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | OK | |
| Nurse Practitioner | OK | |
| Nurse Practitioner | OK | |
| Family Practice | OK | |
| Family Practice, Osteopathic Manipulative Medicine, Sports Medicine | OK | |
| Family Practice | OK | |
| Nurse Practitioner | OK | |
| Physician Assistant | OK | |
| Endocrinology, Internal Medicine | OK | |
| Nurse Practitioner | OK |
Reviews
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