Wallace Medical Group, Inc
NPI 1104047596 · Procedural Dermatology Physician · Beverly Hills, CA
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Wallace Medical Group, Inc is a Procedural Dermatology Physician organization in Beverly Hills, CA (NPI 1104047596).
Provider details
- NPI number
- 1104047596
- Entity type
- Organization
- Primary specialty
- Procedural Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Paul Wallace, Medical Director(310) 652-8460
- License
- A49918 (CA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2007-05-01
- Last updated
- 2007-10-16
Frequently asked questions
- What is Wallace Medical Group, Inc's NPI number?
- Wallace Medical Group, Inc's National Provider Identifier (NPI) is 1104047596, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Wallace Medical Group, Inc?
- Wallace Medical Group, Inc is classified in the NPPES registry as Procedural Dermatology Physician (Allopathic & Osteopathic Physicians).
- Where is Wallace Medical Group, Inc located?
- Wallace Medical Group, Inc's practice location on file with NPPES is 8920 Wilshire Blvd, Beverly Hills, CA 90211-2007.
- What is Wallace Medical Group, Inc's phone number?
- The practice phone number listed in the NPPES registry for Wallace Medical Group, Inc is (310) 652-8460.
- Does Wallace Medical Group, Inc accept Medicare?
- Wallace Medical Group, Inc is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Wallace Medical Group, Inc?
- The authorized official listed on Wallace Medical Group, Inc's NPPES record is Paul Wallace, Medical Director. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Wallace Medical Group, Inc's NPI active?
- Yes — Wallace Medical Group, Inc's NPI (1104047596) is active in the NPPES registry as of the last update on 2007-10-16.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.