DR. PHILIP C WALLACE (MD) – Physical Medicine & Rehabilitation Physician, NPI 1629258322
Physical Medicine & Rehabilitation Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
88 SPORTS MEDICINE in OR
Provider Addresses for DR. PHILIP C WALLACE (MD)
2115 NE WYATT CT
SUITE 101
BEND, OR 977017678
Phone: (541) 323-6280
Fax: (541) 323-6288
Type: Mailing
2115 NE WYATT CT.
101
BEND, OR 977016324
Phone: (541) 323-6280
Fax: (541) 323-6288
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 23 Open Payments records for all available years, with a total value of $383.
Total Amount is formed as General ($383) + Research ($0) + Ownership ($0) = $383.
Last reported payment date: 2024-08-07 • Largest payer in this snapshot: Abbott Laboratories ($275).
Total Amount
$383
General + Research + Ownership
Payments
23
Total payment records
General Amount
$383
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-07
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Abbott Laboratories | $275 |
| Vertos Medical, Inc. | $108 |
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: 2010-11-04
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 |
|---|---|---|---|---|
| I20101104000660 | I | Sports Medicine | OR | 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 |
|---|---|---|---|---|
| 64483 | Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level | 284 | 241 | $0 |
| 64493 | Injection of lower or sacral spine facet joint using imaging guidance, single level | 225 | 139 | $0 |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 182 | 35 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 145 | 105 | $0 |
| 64635 | Destruction of lower or sacral spinal facet joint nerves using imaging guidance, single facet joint | 136 | 97 | $0 |
Insurance plans in this area (ZIP 97701)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | OR |
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