WALLIS DERMATOLOGY ASSOCIATES PLLC – Dermatology Physician, NPI 1396945234
Dermatology Physician
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for WALLIS DERMATOLOGY ASSOCIATES PLLC
Wallis Dermatology Associates, 6, Doctor Circle, Longview, Gregg County, Texas, 75605, United States
LONGVIEW, TX 756055050
Phone: (903) 757-3881
Fax: (903) 757-5948
Type: Mailing
1900 S Washington Ave Ste E
Marshall, TX 756706845
Phone: (903) 503-7330
Fax: (903) 503-7336
Type: Location
2365 Three Lakes Pkwy
Tyler, TX 75703
Phone: (903) 991-4569
Fax: (430) 227-8328
Type: Location
3535 N FOURTH ST STE 400
LONGVIEW, TX 756050038
Phone: (903) 757-3881
Fax: (903) 757-5948
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: 2012-03-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-10-31 (586 days ago).
Enrollment records
1
Earliest due date
2024-10-31
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 |
|---|---|---|---|---|
| O20120322000343 | O | Clinic/Group Practice | TX | 2024-10-31 |
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 75605)
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