JOANNE M WALLIS (PNP) – Primary Care Nurse Practitioner, NPI 1932370756
Primary Care Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for JOANNE M WALLIS (PNP)
12710 SE Division St
Portland, OR 972363134
Phone: (503) 988-3601
Type: Location
Southwest Harvey Milk Street, Chinatown, Old Town, Portland, Metro, Multnomah County, Oregon, 97204, United States
PORTLAND, OR 972042347
Phone: (503) 988-5958
Fax: (503) 988-4093
Type: Mailing
Southeast 34th Street, Fisher, Vancouver, Clark County, Washington, 98683, United States
VANCOUVER, WA 986831450
Phone: (360) 726-6724
Fax: (360) 726-6718
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $125.
Total Amount is formed as General ($125) + Research ($0) + Ownership ($0) = $125.
Last reported payment date: 2023-06-08 • Largest payer in this snapshot: Corium, LLC ($125).
Total Amount
$125
General + Research + Ownership
Payments
1
Total payment records
General Amount
$125
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-06-08
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Corium, LLC | $125 |
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: 2020-04-15
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 |
|---|---|---|---|---|
| I20120119000459 | I | Nurse Practitioner | OR | TBD |
| I20200415001487 | I | Nurse Practitioner | WA | 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 97236)
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Reviews
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