CHARLES ALAN WALLACE (MD) – Plastic and Reconstructive Surgery Physician, NPI 1164422481
Plastic and Reconstructive Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
588 PLASTIC AND RECONSTRUCTIVE SURGERY in TX
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Provider Addresses for CHARLES ALAN WALLACE (MD)
17110, Dallas Parkway, Dallas, Dallas County, Texas, 75001:75287, United States
SUITE 100
DALLAS, TX 752481167
Phone: (972) 380-7090
Fax: (972) 380-7016
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 16 Open Payments records for all available years, with a total value of $760.
Total Amount is formed as General ($760) + Research ($0) + Ownership ($0) = $760.
Last reported payment date: 2024-10-03 • Largest payer in this snapshot: ABBVIE INC. ($621).
Total Amount
$760
General + Research + Ownership
Payments
16
Total payment records
General Amount
$760
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-03
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $621 |
| Integra LifeSciences Corporation | $76 |
| Kerecis Limited | $39 |
| Innovation Technologies Inc | $24 |
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: 2010-12-08
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 |
|---|---|---|---|---|
| I20101208000369 | I | Plastic And Reconstructive Surgery | TX | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 75248)
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