DR. ROBERT D WALLACE (MD) – Plastic and Reconstructive Surgery Physician, NPI 1023075637
Plastic and Reconstructive Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
142 PLASTIC AND RECONSTRUCTIVE SURGERY in TN
Provider Addresses for DR. ROBERT D WALLACE (MD)
1910 Nonconnah Blvd
Suite 120
Memphis, TN 381322113
Phone: (901) 448-2300
Fax: (901) 448-6657
Type: Location
1068 CRESTHAVEN RD STE 500
MEMPHIS, TN 38119
Phone: (901) 866-8525
Type: Location
700, Union Avenue, Medical District, Foote Homes, Memphis, Shelby County, Tennessee, 38103, United States
MEMPHIS, TN 381043641
Phone: (901) 866-8622
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 16 Open Payments records for all available years, with a total value of $18,017.
Total Amount is formed as General ($18,017) + Research ($0) + Ownership ($0) = $18,017.
Last reported payment date: 2024-12-13 • Largest payer in this snapshot: Poriferous LLC ($17,349).
Total Amount
$18,017
General + Research + Ownership
Payments
16
Total payment records
General Amount
$18,017
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-13
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Poriferous LLC | $17,349 |
| REVANCE THERAPEUTICS, INC. | $231 |
| ABBVIE INC. | $188 |
| Kerecis Limited | $71 |
| Aroa Biosurgery Incorporated | $66 |
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: 2010-10-14
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 |
|---|---|---|---|---|
| I20101014000191 | I | Plastic And Reconstructive Surgery | TN | 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 |
|---|---|---|---|---|
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 49 | 49 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 23 | 19 | $0 |
| 14060 | Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less | 11 | 11 | $0 |
Insurance plans in this area (ZIP 38132)
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