KACIE WALLACE GONZALES – Physician Assistant, NPI 1649899600

KACIE WALLACE GONZALES is a healthcare provider. based in Oklahoma city, Oklahoma. specializing in PHYSICIAN ASSISTANT. They hold a License No. 3181 (OK). The NPI Number for KACIE WALLACE GONZALES is 1649899600

Main info

Female
6 Years Of Experience
Accepts Medicare Assignment
Name
KACIE WALLACE GONZALES
NPI
1649899600
Phone
(979) 450-5422
Address
800 N OKLAHOMA AVE APT 2207
Enumeration Date
10 April 2020
Last Update Date
29 January 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9797643090
Graduation Year
2020 (6 years ago)
PAC ID
9830512078
Group Practice PAC ID
5092939033
Professional Enrollment ID
I20211102001362
Address ID
TX766673664ME514XXDXXX500
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience50
Completeness85
Years active:6State licenses:2Digital endpointsOther names

1,797 PHYSICIAN ASSISTANT in OK

Provider Addresses for KACIE WALLACE GONZALES

  • 800 N OKLAHOMA AVE APT 2207

    OKLAHOMA CITY, OK 731044421

    Phone: (979) 450-5422

    Type: Mailing

  • 800 NE 10TH ST

    OKLAHOMA CITY, OK 731045418

    Phone: (405) 271-4022

    Type: Location

  • 2215 E VILLA MARIA RD STE 110

    BRYAN, TX 778022585

    Phone: (979) 776-2000

    Fax: (866) 733-2572

    Type: Mailing

  • 2435 Harvey Mitchell Parkway South

    College Station, TX 77845

    Phone: (979) 776-2000

    Fax: (866) 733-2572

    Type: Location

  • 6270 DILLY SHAW TAP RD

    BRYAN, TX 778088624

    Phone: (979) 450-5422

    Type: Mailing

  • 2805 EARL RUDDER FWY S

    COLLEGE STATION, TX 778456080

    Phone: (979) 764-3090

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 6 Open Payments records for all available years, with a total value of $162.

Total Amount is formed as General ($162) + Research ($0) + Ownership ($0) = $162.

Last reported payment date: 2024-12-12 • Largest payer in this snapshot: GENZYME CORPORATION ($96).

Total Amount

$162

General + Research + Ownership

Payments

6

Total payment records

General Amount

$162

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-12

Latest reported date

Top Companies

Largest payers in this snapshot

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: 2021-11-02

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

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
I20200707002615IPhysician AssistantOKTBD
I20211102001362IPhysician AssistantTXTBD

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
95004Test for allergy using allergenic extract98813$0
J1100Injection, dexamethasone sodium phosphate, 1 mg66439$0
99213Established patient office or other outpatient visit, 20-29 minutes193143$0
99214Established patient office or other outpatient visit, 30-39 minutes167132$0
99203New patient office or other outpatient visit, 30-44 minutes8787$0
View full utilization report →

Insurance plans in this area (ZIP 73104)

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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: 5092939033View full group profile
NameSpecialtyState
Qualified AudiologistIL
O T O L A R Y N G O L O G YTX
Qualified AudiologistTX
O T O L A R Y N G O L O G YTX
Physician AssistantTX

Reviews

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Frequently asked questions

Can I verify KACIE WALLACE GONZALES with an NPI only?
You can start verification with NPI 1649899600 for KACIE WALLACE GONZALES, then check state licensing separately.
Does CMS list KACIE WALLACE GONZALES as active?
Yes — KACIE WALLACE GONZALES is active in the NPI listing used on this page.
What is KACIE WALLACE GONZALES's primary classification?
Physician Assistant is the headline specialty for KACIE WALLACE GONZALES here. Clinical services aligned with this taxonomy classification.
Where should I expect KACIE WALLACE GONZALES on a map?
Expect Oklahoma City, Oklahoma as a primary anchor for KACIE WALLACE GONZALES unless the record lists multiple sites.
How many locations tie to this NPI?
7 practice locations appear in the available data.

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