STEPHANIE MARY WALLACE (MD) – Anesthesiology Physician, NPI 1639304736
Anesthesiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,266 ANESTHESIOLOGY in WI
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Provider Addresses for STEPHANIE MARY WALLACE (MD)
1836, South Avenue, La Crosse, La Crosse County, Wisconsin, 54601, United States
LA CROSSE, WI 546015429
Phone: (608) 782-7300
Type: Mailing
1506 S ONEIDA ST
APPLETON, WI 549151305
Phone: (920) 738-2611
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2013-08-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-08-31 (1016 days ago).
Enrollment records
1
Earliest due date
2023-08-31
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 |
|---|---|---|---|---|
| I20130812000820 | I | Anesthesiology | WI | 2023-08-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 54601)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| ANESTHESIOLOGY | WI | 00142 | Anesthesia for lens surgery | 168 | 152 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Certified Registered Nurse Anesthetist (Crna) | WI | |
| - | WI | |
| U R O L O G Y | WI | |
| - | WI | |
| P S Y C H I A T R Y | WI | |
| Certified Registered Nurse Anesthetist (Crna) | WI | |
| Vascular Surgery, General Surgery | WI | |
| - | ND | |
| Nephrology, Internal Medicine | WI | |
| Family Practice | WI |
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