DR. SHANA DALE WALLACE MD
NPI 1013040666
Psychiatry & Neurology - Neurology with Special Qualifications in Child Neurology in Charlotte, NC
NPI Status: Active since March 13, 2007
Contact Information
1900 RANDOLPH RD
SUITE 1010
CHARLOTTE, NC
ZIP 28207
Phone: (704) 384-1390
Fax: (704) 384-1063
- Individual
- Female
- Psychiatry & Neurology
- Neurology with Special Qualifications in...
- Accepts Insurance
- PECOS Enrolled
About SHANA WALLACE
This page provides the complete NPI Profile along with additional information for Shana Wallace, a provider established in Charlotte, North Carolina with a medical specialization in Psychiatry & Neurology, focusing in neurology with special qualifications in child neurology . The healthcare provider is registered in the NPI registry with number 1013040666 assigned on March 2007. The practitioner's primary taxonomy code is 2084N0402X with license number 200401063 (NC). The provider is registered as an individual and her NPI record was last updated 5 years ago.
- NPI
- 1013040666
- Provider Name
- DR. SHANA DALE WALLACE MD
- Other Name
- DR. SHANA DALE GREEN MD
- Other Name Type
- Former Name (1)
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 1900 RANDOLPH RD SUITE 1010 CHARLOTTE, NC 28207
- Location Phone
- (704) 384-1390
- Location Fax
- (704) 384-1063
- Mailing Address
- PO BOX 60447 CHARLOTTE, NC 28260
- Mailing Phone
- (704) 384-1390
- Mailing Fax
- (704) 384-1063
- Is Sole Proprietor?
- No
- Enumeration Date
- 03-13-2007
- Last Update Date
- 10-25-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Psychiatry & Neurology Neurology with Special Qualifications in Child Neurology
- Taxonomy Code
- 2084N0402X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 200401063
- License State
- NC
- Taxonomy Description
- A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 2080P0008X | Allopathic & Osteopathic Physicians | Pediatrics | 2004-01063 (NC) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Advantage Bronze Basic | 3 Free PCP | $20 Tier 1 Rx | Integrated | Nationwide Doctors - PPO
- Blue Advantage Bronze Complete | $60 PCP | $20 Tier 1 Rx | Nationwide Doctors - PPO
- Blue Advantage Bronze Standard | Nationwide Doctors - PPO
- Blue Advantage Gold Premier | 3 Free PCP | $10 Tier 1 Rx | Nationwide Doctors - PPO
- Blue Advantage Gold Standard | Nationwide Doctors - PPO
- Blue Advantage Silver Choice | 3 Free PCP | $15 Tier 1 Rx | Nationwide Doctors - PPO
- Blue Advantage Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | Nationwide Doctors - PPO
- Blue Advantage Silver Standard | Nationwide Doctors - PPO
- Blue Care Bronze Standard | Statewide Doctors - HMO
- Blue Care Gold Standard | Statewide Doctors - HMO
- Bronze First 7500 $25 Generic Drugs - HMO
- Bronze First 7500 $25 Generic Drugs Adult Vision & Fitness - HMO
- Core Gold 1500 $10 Generic Drugs - HMO
- Core Gold 1500 $10 Generic Drugs Adult Vision & Fitness - HMO
- Diabetes Gold 1100 $0 Select Drugs & Specialized Services - HMO
- Diabetes Gold 1100 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
- Diabetes Silver 4000 $0 Select Drugs & Specialized Services - HMO
- Diabetes Silver 4000 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
- Gold 1500 $15 Generic Drugs - HMO
- Gold 1500 $15 Generic Drugs Adult Vision & Fitness - HMO
- Connect Bronze 5500 Indiv Med Deductible - HMO
- Connect Bronze 6500 Indiv Med Deductible - HMO
- Connect Bronze CMS Standard - HMO
- Connect Gold CMS Standard - HMO
- Connect Silver 3500 Indiv Med Deductible - HMO
- Connect Silver 4400 Indiv Med Deductible - HMO
- Connect Silver CMS Standard - HMO
- Standard Expanded Bronze WellCare - PPO
- Standard Gold WellCare - PPO
- Standard Silver WellCare - PPO
- WellCare Secure Health Bronze - PPO
- WellCare Secure Health Gold - PPO
- WellCare Secure Health Silver - PPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 5907566 | MEDICAID (05) | NC | |
| 200401063 | OTHER (01) | NC | MEDICAL LICENSE |
Medicare Participation & PECOS Enrollment Status
Shana Wallace is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Physician Visit Costs
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 28207 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $125.01
- Minimum New Patient Price $54.12
- Maximum New Patient Price $165.09
- Average New Patient Copayment $31.25
- Minimum New Patient Copayment $13.53
- Maximum New Patient Copayment $41.27
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $95.94
- Minimum Established Patient Price $17.21
- Maximum Established Patient Price $134.61
- Average Established Patient Copayment $23.98
- Minimum Established Patient Copayment $4.3
- Maximum Established Patient Copayment $33.65
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Reviews for DR. SHANA DALE WALLACE MD
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 0 | 1 | 3 | 0 | 4 | 0 | 6 | 6 | 6 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 0 | 2 | 3 | 0 | 4 | 0 | 6 | 12 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 0 + 2 + 3 + 0 + 4 + 0 + 6 + 1 + 2 + 24 = 44 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 50 - 44 = 6 | 6 | ||||||||
The NPI number 1013040666 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1376529859 | MR. DAVID E SOMERSTEIN MD Individual | Urology | 1900 RANDOLPH RD SUITE 310 CHARLOTTE, NC 28207 (704) 358-8780 |
| 1972577369 | TRISHA R MCCREIGHT P.A. Individual | Physician Assistant (Medical) | 1900 RANDOLPH RD STE 900 CHARLOTTE, NC 28207 (704) 377-2424 |
| 1003866443 | JOHN B CLARK JR. M.D. Individual | Emergency Medicine | 1900 RANDOLPH RD STE 900 CHARLOTTE, NC 28207 (704) 377-2424 |
| 1134179542 | JAMES A DAVIS M.D Individual | Emergency Medicine | 1900 RANDOLPH RD STE 900 CHARLOTTE, NC 28207 (704) 377-2424 |
| 1063462737 | JAMES E PUGH MD Individual | Psychiatry & Neurology (Neurology) | 1900 RANDOLPH RD SUITE 1010 CHARLOTTE, NC 28207 (704) 334-7311 |
| 1730131350 | SIDNEY M FLETCHER M.D. Individual | Emergency Medicine | 1900 RANDOLPH RD STE 900 CHARLOTTE, NC 28207 (704) 377-2424 |
| 1679526719 | DR. BARBARA M GUISE M.D. Individual | Emergency Medicine | 1900 RANDOLPH RD STE 900 CHARLOTTE, NC 28207 (704) 377-2424 |
| 1093769630 | HARRY E SIBOLD M.D. Individual | Emergency Medicine | 1900 RANDOLPH RD STE 900 CHARLOTTE, NC 28207 (704) 377-2424 |
| 1073566956 | EDWIN T HOLLOWAY M.D. Individual | Emergency Medicine | 1900 RANDOLPH RD STE 900 CHARLOTTE, NC 28207 (704) 377-2424 |
| 1629024070 | JEFFREY A KLEIN M.D. Individual | Emergency Medicine | 1900 RANDOLPH RD STE 900 CHARLOTTE, NC 28207 (704) 377-2424 |
| 1720026008 | RICHARD L SUTTON M.D. Individual | Emergency Medicine | 1900 RANDOLPH RD STE 900 CHARLOTTE, NC 28207 (704) 377-2424 |
| 1083651319 | JOHN W RINGWOOD M.D. Individual | Emergency Medicine (Pediatric Emergency Medicine) | 1900 RANDOLPH RD STE 900 CHARLOTTE, NC 28207 (704) 377-2424 |
| 1760408967 | TIMOTHY M SULLIVAN MD Individual | Emergency Medicine | 1900 RANDOLPH RD STE 900 CHARLOTTE, NC 28207 (704) 377-2424 |
| 1528072105 | DR. DAVID BRIAN WILLIAMS DDS Individual | Dentist (General Practice) | 1900 RANDOLPH RD SUITE 404 CHARLOTTE, NC 28207 (704) 375-6831 |
| 1831249754 | NATHAN PAUL RHODES M.D. Individual | Emergency Medicine | 1900 RANDOLPH RD STE 900 CHARLOTTE, NC 28207 (704) 377-2424 |
| 1578619235 | REBECCAH SHIERSON WICKERHAM MD Individual | Emergency Medicine | 1900 RANDOLPH RD SUITE 900 CHARLOTTE, NC 28207 (704) 377-2424 |
| 1619012150 | DUNCAN MORTON JR. M.D. Individual | Surgery (Pediatric Surgery) | 1900 RANDOLPH RD SUITE 210 CHARLOTTE, NC 28207 (704) 370-0223 |
| 1558548156 | DR. KRISHNARAJ JAYARAMA D.O. Individual | Emergency Medicine | 1900 RANDOLPH RD STE 900 CHARLOTTE, NC 28207 (704) 377-2424 |
| 1114160520 | KEVIN WARREN GREER MD Individual | Emergency Medicine | 1900 RANDOLPH RD STE 900 CHARLOTTE, NC 28207 (704) 377-2424 |
| 1124335427 | PPG PATHOLOGY AND DIAGNOSTICS PLLC Organization | Clinical Medical Laboratory | 1900 RANDOLPH RD SUITE 708 CHARLOTTE, NC 28207 (704) 644-5579 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1013040666, enumerated in the NPI registry as an "individual" on March 13, 2007
The provider is located at 1900 Randolph Rd Suite 1010 Charlotte, Nc 28207 and the phone number is (704) 384-1390
The provider's speciality is Psychiatry & Neurology with taxonomy code 2084N0402X with a focus in Neurology with Special Qualifications in Child Neurology
The provider might be accepting Accepts: Blue Cross and Blue Shield of NC, CareSource,. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
Medicare beneficiaries should expect a typical cost of $125.01 with an average copayment of $31.25 for new patient appointments. Established patients should expect a typical charge of $95.94 and an average copayment of 23.98. Please review your insurance plan or contact the provider directly to determine your specific costs.
This NPI record was last updated on March 13, 2007. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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