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Active NPI 1851305304 Individual Practitioner Female Practitioner

Mindy Lee Wallace , RD LDN

Dietitian, Registered • Quincy, IL

Professional Overview & Biography Verified Profile Summary

Mindy Wallace, RD LDN is a registered healthcare professional specializing in Dietitian, Registered in Quincy, IL. Practice services are available at 935 JERSEY ST under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

935 Jersey St

Quincy, IL 623014030

Telephone 2172282413
Fax 2172282416

Specialty Benchmarks & Practice Insights

Comparative analytics for Dietitian, Registered in Quincy, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 25.0 Yrs
State Avg: 16.7 Yrs
Regional Practice Density
15 Specialists

Practicing in Quincy, IL (2895 Statewide)

Telehealth Adoption Rate
6.7% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dietitian, Registered Primary Specialty

NUCC Taxonomy Code: 133V00000X

State License IL 164003636

A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.

Dietitian, Registered

NUCC Taxonomy Code: 133V00000X

State License MO 2005004105

A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Blue Cross Blue Shield Il
00132009 (IL)
Commercial Insurance / Payer ID Quincy Health Care Manage
075113 (IL)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Kimberly Otter , RD LDN

Dietitian, Registered

NPI 1245232909

RDLDN

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active September 22, 2008

NPI status registered as active in NPPES database

📍
Updated Practice Location September 22, 2008

Registered at 935 JERSEY ST, QUINCY, IL 623014030 (Tel: 2172282413)

📍
Updated Business Mailing Address September 22, 2008

Registered at 2820 E BLUFF CT, QUINCY, IL 623051329 (Tel: 2174406458)

👤
Provider Name / Credentials Updated September 22, 2008

Recorded as MINDY WALLACE, RD LDN

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 22, 2008

Dietitian, Registered (License #164003636 in IL)

🟢
Initial NPI Registration & Enumeration July 28, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1851305304
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 28, 2006
Last Update: September 22, 2008
Sole Proprietor: No

Mailing Address

2820 E Bluff Ct

Quincy, IL 623051329

Phone: 2174406458

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.