KELLIE L WALLACE-WILDING (MD) – Family Medicine Physician, NPI 1063518629
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,210 FAMILY PRACTICE in TN
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Provider Addresses for KELLIE L WALLACE-WILDING (MD)
400, Jackson County, Oregon, United States
JACKSON, TN 383020400
Phone: (731) 423-8697
Fax: (731) 422-5743
Type: Mailing
45, Sycamore Street, Jackson, Madison County, Tennessee, 38301, United States
JACKSON, TN 383053618
Phone: (731) 664-1375
Fax: (731) 664-1378
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 4 Open Payments records for all available years, with a total value of $502.
Total Amount is formed as General ($62) + Research ($440) + Ownership ($0) = $502.
Last reported payment date: 2024-09-19 • Largest payer in this snapshot: Eli Lilly and Company ($440).
Total Amount
$502
General + Research + Ownership
Payments
4
Total payment records
General Amount
$62
General payments
Research Amount
$440
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-19
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Eli Lilly and Company | $440 |
| Teleflex LLC | $25 |
| ABBVIE INC. | $20 |
| IMPEL PHARMACEUTICALS INC. | $17 |
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: 2007-01-25
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 |
|---|---|---|---|---|
| I20070125000551 | I | Family Practice | 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 |
|---|---|---|---|---|
| J0897 | Injection, denosumab, 1 mg | 2,340 | 25 | $0 |
| 36415 | Insertion of needle into vein for collection of blood sample | 815 | 420 | $0 |
| 80053 | Blood test, comprehensive group of blood chemicals | 683 | 402 | $0 |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 645 | 395 | $0 |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 460 | 291 | $0 |
Insurance plans in this area (ZIP 38302)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | TN | |
| Family Practice | TN | |
| E N D O C R I N O L O G Y | TN | |
| - | TN | |
| - | TN | |
| G A S T R O E N T E R O L O G Y | TN | |
| O P T O M E T R Y | TN | |
| Certified Registered Nurse Anesthetist (Crna) | TN | |
| Interventional Cardiology, Cardiovascular Disease (Cardiology) | TN | |
| Certified Registered Nurse Anesthetist (Crna) | TN |
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