DR. ADAM DONALD WALLACE (MD) – Neurology with Special Qualifications in Child Neurology Physician, NPI 1386969079
Neurology with Special Qualifications in Child Neurology Physician
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DR. ADAM DONALD WALLACE (MD)
744 S Webster Ave
Green Bay, WI 543013505
Phone: (920) 445-7222
Fax: (920) 445-7289
Type: Location
200 1st St SW
Rochester, MN 55905
Phone: (507) 284-2511
Type: Location
8201 E Riverside Blvd
Rockford, IL 611142300
Phone: (815) 971-2000
Type: Location
1836 South Ave
LA Crosse, WI 546015429
Phone: (608) 782-7300
Type: Location
7974, UW Health Court, Discovery Springs, City of Middleton, Dane County, Wisconsin, 53562, United States
MIDDLETON, WI 535625531
Phone: (608) 829-5485
Type: Mailing
1st Street Southwest, Rochester, Olmsted County, Minnesota, 55903, United States
ROCHESTER, MN 55905
Phone: (507) 284-2511
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $46.
Total Amount is formed as General ($46) + Research ($0) + Ownership ($0) = $46.
Last reported payment date: 2024-11-06 • Largest payer in this snapshot: Imperative Care, Inc ($25).
Total Amount
$46
General + Research + Ownership
Payments
2
Total payment records
General Amount
$46
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-06
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Imperative Care, Inc | $25 |
| Orthofix Medical, Inc. | $20 |
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: 2020-11-16
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20170804002869 | I | Neurology | WI | TBD |
| I20201116001464 | I | Neurology | IL | 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 54301)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WI | |
| - | WI | |
| Nurse Practitioner | WI | |
| Nurse Practitioner | WI | |
| Family Practice | WI | |
| - | WI | |
| - | WI | |
| - | WI | |
| Endocrinology, Internal Medicine | WI | |
| Medical Oncology, Hematology/Oncology | CA |
Reviews
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