Tasha B Wallace


Address: 3400 Lee Blvd, Suite 108, Lehigh Acres, FL 33971-1309

Tasha B Wallace (NPI# 1396736997, PAC ID# 3173626835) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.

Physician Overview

Nation Provider ID (NPI) 1396736997
PAC ID by PECOS 3173626835
Professional Enrollment ID I20070317000058
Full Name Tasha B Wallace
Address 3400 Lee Blvd
Suite 108
Lehigh Acres
FL 33971-1309
Gender F
Credential DO
Medical School UMDNJ NEW JERSEY SCHOOL OF OSTEO MEDICINE
Graduation Year 2000
Primary Specialty FAMILY MEDICINE
Accepts Medicare Assignment Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
100107 LEHIGH REGIONAL MEDICAL CENTER
100244 CAPE CORAL HOSPITAL - 100244

Other Locations

Address Phone Organization
3400 Lee Blvd, Suite 108, Lehigh Acres, FL 33971-1309

Individual EP (Eligible Professionals) Public Reporting – Performance Scores
Physician Quality Reporting System (PQRS) and non-PQRS Qualified Clinical Data Registry (QCDR)

Measure Identifier Measure Title Performance Rate Reporting Mechanism
ACI_EC_TRANS_PPHI_1 Security Risk Analysis %

Organization Information

Office Location

Street Address 3400 LEE BLVD
SUITE 108
City LEHIGH ACRES
State FL
Zip 33971-1309

Physicians in the same location

Name Specialty Organization Address
Peter Joseph Curcione Orthopedic Surgery Kagan Jugan and Associates Pa 3400 Lee Blvd, Suite 105, Lehigh Acres, FL 33971-1309

Physicians in the same zip code

Name Specialty Organization Address
Tahrim Rahman Optometry Eye Health of Ft Myers Inc 5220 Lee Blvd, Building 9, Lehigh Acres, FL 33971-1021
Stephanie E Gebara Physician Assistant Innovative Dermatology and Mohs Surgery LLC 3507 Lee Blvd, Suite 107, Lehigh Acres, FL 33971-1303
Michael Spencer Optometry Eye Centers of Florida 3507 Lee Blvd, Suite 104, Lehigh Acres, FL 33971-1303
Joseph Legiec Optometry 2523 Lee Blvd, Lehigh Acres, FL 33971-1413
Dana Chantel Trahan Nurse Practitioner Gulf Coast Healthcare Systems, Inc 2718 Lee Blvd, Suite B, Lehigh Acres, FL 33971-1537
Frank M Finch Physician Assistant Gulf Coast Healthcare Systems, Inc 2718 Lee Blvd, Suite B, Lehigh Acres, FL 33971-1537
Laura Lemmenes Nurse Practitioner Gulf Coast Healthcare Systems, Inc 2718 Lee Blvd, Suite B, Lehigh Acres, FL 33971-1537
Habib A Azizi Optometry 2814 Lee Blvd, Suite 3, Lehigh Acres, FL 33971-1542
Gordon J Kleinpell Podiatry Associates In Medicine and Surgery LLC 2814 Lee Blvd, Suite 2, Lehigh Acres, FL 33971-1561
Dolores Y Delgado Internal Medicine Panamerican Internal Medicine Inc 2814 Lee Blvd, Suite 15, Lehigh Acres, FL 33971-1561
Find all physicians in zip 33971

Competitor

Search similar physicians

City LEHIGH ACRES
Zip Code 33971
Specialty FAMILY MEDICINE
City + Specialty LEHIGH ACRES + FAMILY MEDICINE

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS)
Jurisdiction Medicare

This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.

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