Active NPI 1124121934 Individual Practitioner Male Practitioner

Dr. Jeffrey M Wallentine , MD

Orthopaedic Surgery • Provo, UT

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Jeffrey Wallentine, MD is a certified Orthopaedic Surgery practicing in Provo, UT. With approximately 34 years of clinical experience since graduating from University Of Utah School Of Medicine in 1992, Dr. Wallentine delivers high-quality medical care to the local community at 1055 N 500 W.

Dr. Wallentine is affiliated with Revere Health Pc and accepts Medicare assignment.

Frequently performed procedures and clinical services include injection, triamcinolone acetonide, not otherwise specified, 10 mg, established patient outpatient office visit, aspiration and/or injection of fluid from large joint. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1055 N 500 W
Suite 121

Provo, UT 846043305

Telephone 8013737350

Fax 8018125401

Associated Practice Facility / Clinic

🏢 No Roll Up Timpanogos Llc Facility NPI 1831153840

Medicare Profile & Education

Medical School

University Of Utah School Of Medicine

Graduation Year

1992

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Orthopaedic Surgery in Provo, UT

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

34 Yrs +11.0 yrs vs City Avg

City Avg: 23.0 Yrs

State Avg: 21.4 Yrs

Regional Practice Density

26 Specialists

Practicing in Provo, UT (277 Statewide)

Telehealth Adoption Rate

3.8% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

65.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Wallentine (34 Years) 34 Yrs

Provo Specialty Average (23.0 Years) 23.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	536	94	$3.00	$0.99
99213 Established patient office or other outpatient visit, typically 15 minutes	160	136	$152.76	$85.83
20610 Aspiration and/or injection of fluid from large joint	143	116	$202.38	$70.41
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	133	119	$215.61	$121.65
73564 X-ray of knee, 4 or more views	99	75	$135.80	$42.45
73562 X-ray of knee, 3 views	84	65	$117.67	$37.23
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	78	71	$13.92	$7.45
36415 Insertion of needle into vein for collection of blood sample	77	71	$15.92	$8.46
27447 Replacement of knee joint, both sides of knee	77	74	$3202.00	$1206.99
73502 X-ray of hip, 2-3 views	56	49	$133.07	$42.30
0055T Musculoskeletal surgical navigational orthopedic operation using imaging guidance	54	53	$433.00	$219.82
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	47	47	$281.62	$156.54
85652 Red blood cell sedimentation rate, to detect inflammation, automated	42	42	$6.00	$2.60
86140 Measurement C-reactive protein for detection of infection or inflammation	42	42	$11.00	$4.98
80053 Blood test, comprehensive group of blood chemicals	38	34	$22.95	$10.12
81001 Manual urinalysis test with examination using microscope, automated	37	34	$16.00	$3.04
J7323 Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose	27	13	$203.00	$117.97
73030 X-ray of shoulder, minimum of 2 views	24	20	$102.83	$32.44
27130 Replacement of thigh bone and hip joint with prosthesis	22	21	$2994.00	$1215.61
72100 X-ray of lower and sacral spine, 2-3 views	17	17	$112.06	$35.47
29826 Shaving of part of shoulder bone and repair of ligament using an endoscope	14	14	$1422.00	$161.24
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	13	13	$187.85	$105.41
29824 Partial removal of collar bone at shoulder using an endoscope	13	13	$1444.62	$266.85

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	388	77	$3.00	$1.04
99213 Established patient office or other outpatient visit, typically 15 minutes	139	115	$149.77	$84.20
20610 Aspiration and/or injection of fluid from large joint	116	96	$182.90	$64.85
36415 Insertion of needle into vein for collection of blood sample	115	86	$14.57	$8.40
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	113	103	$211.71	$120.14
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	108	79	$13.12	$7.61
73564 X-ray of knee, 4 or more views	90	69	$134.50	$41.86
27447 Replacement of knee joint, both sides of knee	85	80	$3202.00	$1210.13
73502 X-ray of hip, 2-3 views	77	58	$136.84	$43.79
73562 X-ray of knee, 3 views	71	59	$112.87	$36.06
86140 Measurement C-reactive protein for detection of infection or inflammation	64	51	$11.00	$5.08
85652 Red blood cell sedimentation rate, to detect inflammation, automated	64	51	$6.00	$2.65
81001 Manual urinalysis test with examination using microscope, automated	52	42	$16.00	$3.11
80053 Blood test, comprehensive group of blood chemicals	46	41	$22.24	$10.35
27130 Replacement of thigh bone and hip joint with prosthesis	41	40	$2995.59	$1202.44
73030 X-ray of shoulder, minimum of 2 views	36	32	$100.67	$32.29
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	36	36	$277.53	$158.66
72100 X-ray of lower and sacral spine, 2-3 views	25	25	$116.76	$37.45
J7323 Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose	23	15	$203.00	$128.33
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	21	21	$186.10	$106.50

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	416	70	$3.13	$1.14
99213 Established patient office or other outpatient visit, typically 15 minutes	166	138	$147.92	$87.08
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	128	115	$208.85	$122.56
20610 Aspiration and/or injection of fluid from large joint	125	89	$198.12	$68.67
73562 X-ray of knee, 3 views	107	79	$105.93	$34.90
73564 X-ray of knee, 4 or more views	91	68	$132.74	$42.43
27447 Replacement of knee joint, both sides of knee	82	74	$3241.05	$1204.93
36415 Insertion of needle into vein for collection of blood sample	80	67	$10.00	$2.93
73502 X-ray of hip, 2-3 views	75	60	$129.32	$42.54
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	75	64	$14.00	$7.60
86140 Measurement C-reactive protein for detection of infection or inflammation	47	41	$11.00	$5.13
85652 Red blood cell sedimentation rate, to detect inflammation, automated	45	39	$6.00	$2.67
J7323 Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose	43	17	$245.49	$126.88
27130 Replacement of thigh bone and hip joint with prosthesis	36	36	$3008.22	$1236.35
81001 Manual urinalysis test with examination using microscope, automated	34	31	$16.00	$3.06
73030 X-ray of shoulder, minimum of 2 views	33	25	$98.94	$32.56
80053 Blood test, comprehensive group of blood chemicals	33	32	$23.00	$10.17
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	32	32	$286.81	$161.05
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	16	16	$186.81	$102.60
72100 X-ray of lower and sacral spine, 2-3 views	16	16	$114.75	$37.72
29827 Repair of shoulder rotator cuff using an endoscope	15	15	$2363.40	$1029.49
29826 Shaving of part of shoulder bone and repair of ligament using an endoscope	15	15	$1414.13	$166.50
29824 Partial removal of collar bone at shoulder using an endoscope	14	14	$1482.57	$232.84
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	12	12	$91.92	$53.81

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	430	85	$4.85	$1.28
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	139	127	$206.50	$123.81
20610 Aspiration and/or injection of fluid from large joint	131	106	$195.05	$67.93
99213 Established patient office or other outpatient visit, typically 15 minutes	128	101	$146.35	$86.72
73564 X-ray of knee, 4 or more views	117	85	$128.59	$42.53
27447 Replacement of knee joint, both sides of knee	108	97	$3231.65	$1242.23
73562 X-ray of knee, 3 views	92	80	$111.15	$36.28
36415 Insertion of needle into vein for collection of blood sample	70	55	$10.00	$3.00
73502 X-ray of hip, 2-3 views	68	58	$127.22	$40.83
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	58	48	$14.17	$7.77
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	44	44	$283.16	$162.55
86140 Measurement C-reactive protein for detection of infection or inflammation	41	35	$11.00	$5.18
85652 Red blood cell sedimentation rate, to detect inflammation, automated	39	33	$6.00	$2.70
27130 Replacement of thigh bone and hip joint with prosthesis	34	33	$3051.00	$1228.67
73030 X-ray of shoulder, minimum of 2 views	32	26	$95.91	$31.98
J7323 Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose	29	13	$377.00	$113.68
72100 X-ray of lower and sacral spine, 2-3 views	28	28	$111.71	$37.20
80053 Blood test, comprehensive group of blood chemicals	27	22	$23.00	$10.56
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	21	21	$184.62	$108.43
29826 Shaving of part of shoulder bone and repair of ligament using an endoscope	19	18	$1372.32	$169.87
29824 Partial removal of collar bone at shoulder using an endoscope	18	18	$1480.00	$379.04
81001 Manual urinalysis test with examination using microscope, automated	17	16	$16.00	$3.17
29827 Repair of shoulder rotator cuff using an endoscope	12	11	$2353.00	$1042.97

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	562	98	$3.00	$1.42
99213 Established patient office or other outpatient visit, typically 15 minutes	320	230	$134.03	$71.34
20610 Aspiration and/or injection of fluid from large joint	164	120	$180.82	$63.76
73564 X-ray of knee, 4 or more views	107	79	$118.58	$38.66
73502 X-ray of hip, 2-3 views	87	67	$119.17	$39.95
73562 X-ray of knee, 3 views	85	70	$103.34	$35.19
36415 Insertion of needle into vein for collection of blood sample	74	55	$10.00	$2.97
27447 Replacement of knee joint, both sides of knee	71	68	$3191.11	$1335.23
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	66	50	$15.94	$7.61
86140 Measurement C-reactive protein for detection of infection or inflammation	63	48	$11.00	$5.08
20985 Computer-assisted surgery for muscle and bone procedure	59	55	$335.00	$148.34
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	45	45	$195.13	$103.07
J7323 Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose	40	17	$376.95	$133.92
73030 X-ray of shoulder, minimum of 2 views	39	35	$87.85	$28.26
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	31	30	$81.48	$43.65
85651 Red blood cell sedimentation rate, to detect inflammation, non-automated	30	22	$7.87	$4.10
72100 X-ray of lower and sacral spine, 2-3 views	30	30	$103.73	$33.60
27130 Replacement of thigh bone and hip joint with prosthesis	28	26	$3052.11	$1367.73
85652 Red blood cell sedimentation rate, to detect inflammation, automated	28	25	$6.00	$2.62
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	26	26	$195.27	$102.80
29826 Shaving of part of shoulder bone and repair of ligament using an endoscope	20	20	$1432.20	$176.78
73560 X-ray of knee, 1-2 views	18	12	$83.56	$26.51
29827 Repair of shoulder rotator cuff using an endoscope	18	18	$2352.78	$1028.22
29824 Partial removal of collar bone at shoulder using an endoscope	17	17	$1479.82	$260.69
73010 X-ray of shoulder blade	15	14	$78.40	$24.03

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	582	101	$3.00	$1.51
99213 Established patient office or other outpatient visit, typically 15 minutes	300	240	$122.86	$72.17
20610 Aspiration and/or injection of fluid from large joint	164	125	$198.55	$64.03
73564 X-ray of knee, 4 or more views	133	100	$111.20	$37.47
27447 Replacement of knee joint, both sides of knee	112	105	$3363.16	$1397.60
73502 X-ray of hip, 2-3 views	107	85	$111.69	$36.12
73562 X-ray of knee, 3 views	101	83	$96.86	$32.45
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	81	81	$182.78	$105.72
20985 Computer-assisted surgery for muscle and bone procedure	74	72	$334.39	$151.31
36415 Insertion of needle into vein for collection of blood sample	74	62	$10.00	$2.90
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	64	53	$15.08	$8.46
86140 Measurement C-reactive protein for detection of infection or inflammation	61	51	$11.00	$5.63
85651 Red blood cell sedimentation rate, to detect inflammation, non-automated	57	48	$7.00	$4.18
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	56	48	$73.86	$41.66
27130 Replacement of thigh bone and hip joint with prosthesis	55	53	$3131.36	$1335.56
J7323 Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose	42	17	$376.00	$133.69
73030 X-ray of shoulder, minimum of 2 views	29	28	$80.72	$25.67
72100 X-ray of lower and sacral spine, 2-3 views	24	23	$99.83	$33.48
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	21	21	$182.00	$106.81
29826 Shaving of part of shoulder bone and repair of ligament using an endoscope	17	17	$1469.41	$181.86
29824 Partial removal of collar bone at shoulder using an endoscope	15	15	$1480.00	$269.79
29827 Repair of shoulder rotator cuff using an endoscope	15	15	$2352.00	$1071.77

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	501	91	$3.00	$1.76
99213 Established patient office or other outpatient visit, typically 15 minutes	256	198	$122.00	$69.63
20610 Aspiration and/or injection of fluid from large joint	147	108	$186.24	$62.67
73564 X-ray of knee, 4 or more views	80	58	$109.00	$37.00
27447 Replacement of knee joint, both sides of knee	80	74	$3702.30	$1385.90
73562 X-ray of knee, 3 views	65	53	$92.54	$31.68
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	60	60	$181.00	$104.19
73502 X-ray of hip, 2-3 views	59	49	$104.76	$36.09
20985 Computer-assisted surgery for muscle and bone procedure	53	51	$320.00	$150.57
36415 Insertion of needle into vein for collection of blood sample	53	41	$10.00	$2.94
J7323 Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose	49	25	$376.00	$141.24
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	48	37	$16.00	$9.40
86140 Measurement C-reactive protein for detection of infection or inflammation	46	35	$11.00	$6.26
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	46	46	$72.00	$42.41
73030 X-ray of shoulder, minimum of 2 views	32	26	$79.31	$27.15
85652 Red blood cell sedimentation rate, to detect inflammation, automated	23	21	$6.00	$3.26
29826 Shaving of part of shoulder bone and repair of ligament using an endoscope	23	23	$1412.00	$179.70
27130 Replacement of thigh bone and hip joint with prosthesis	23	23	$3614.00	$1328.36
85651 Red blood cell sedimentation rate, to detect inflammation, non-automated	23	16	$7.00	$4.29
29827 Repair of shoulder rotator cuff using an endoscope	21	21	$2380.00	$1051.79
29824 Partial removal of collar bone at shoulder using an endoscope	19	19	$1494.00	$293.18
72100 X-ray of lower and sacral spine, 2-3 views	15	15	$96.00	$32.84

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	578	101	$3.00	$1.73
99213 Established patient office or other outpatient visit, typically 15 minutes	252	187	$116.00	$69.56
20610 Aspiration and/or injection of fluid from large joint	202	121	$161.57	$49.48
20985 Computer-assisted surgery for muscle and bone procedure	91	84	$306.00	$150.05
27447 Replacement of knee joint, both sides of knee	91	85	$3238.20	$1373.66
73564 X-ray of knee, 4 or more views	81	55	$109.00	$37.09
73562 X-ray of knee, 3 views	56	46	$86.59	$27.92
J7323 Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose	55	28	$376.00	$115.45
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	52	52	$172.00	$103.26
73502 X-ray of hip, 2-3 views	45	39	$106.71	$36.52
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	40	35	$69.00	$37.98
36415 Insertion of needle into vein for collection of blood sample	38	36	$10.00	$2.94
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	36	34	$12.00	$7.11
86140 Measurement C-reactive protein for detection of infection or inflammation	33	31	$12.00	$6.96
27130 Replacement of thigh bone and hip joint with prosthesis	29	27	$3594.00	$1366.88
73030 X-ray of shoulder, minimum of 2 views	27	21	$80.00	$27.43
85651 Red blood cell sedimentation rate, to detect inflammation, non-automated	21	20	$8.00	$4.77
29826 Shaving of part of shoulder bone and repair of ligament using an endoscope	20	20	$1412.00	$179.58
29827 Repair of shoulder rotator cuff using an endoscope	18	18	$2091.00	$1054.82
72100 X-ray of lower and sacral spine, 2-3 views	17	17	$93.18	$31.80
29824 Partial removal of collar bone at shoulder using an endoscope	16	16	$1312.00	$230.71
85652 Red blood cell sedimentation rate, to detect inflammation, automated	12	11	$6.00	$3.63

Medical Specialties & State Licenses

CMS Verified: 2020-02-13

Orthopaedic Surgery Primary Specialty

NUCC Taxonomy Code: 207X00000X

State License UT 356423-1205

An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

870281028000 (UT)

Commercial Insurance / Payer ID Pehp

68080 (UT)

Commercial Insurance / Payer ID Utah Healthcare

09-00180 (UT)

Commercial Insurance / Payer ID Dmba

344490 (UT)

Commercial Insurance / Payer ID Altius

QM000056640 (UT)

Commercial Insurance / Payer ID Palmetto

200045124 (UT)

Commercial Insurance / Payer ID Ihc

107008449102 (UT)

Commercial Insurance / Payer ID Emia

870281028WAL (UT)

Hospital & Practice Group Affiliations

Revere Health Pc

1055 N 500, Provo, UT 846043305

Phone: 8014298000

Secondary Practice Locations

700 W 800 N Ste 100

Orem, UT 840576301

Phone: 8013737350

65 E 100 N, Ste A

Gunnison, UT 84634

Phone: 8013737350

1100 S Medical Dr

Mt Pleasant, UT 846472222

Phone: 8013737350

555 W Sr 164

Salem, UT 84653

Phone: 8013737350

1130 Smith Fieldhouse

Provo, UT 846022246

Phone: 8013737350

Practice Associates & Co-Workers

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

35 Associated Practitioners

Dr. Scott Evans , MD

Orthopaedic Surgery - Hand Surgery

NPI 1033435045

Doctor of Medicine (M.D.)

Dr. Evan Nielsen , MD

Orthopaedic Surgery

NPI 1043527260

Doctor of Medicine (M.D.)

Zachary Golden , PA

Physician Assistant

NPI 1053856542

Physician Assistant

Dr. Bradford Matthews , MD

Orthopaedic Surgery

NPI 1063523959

Doctor of Medicine (M.D.)

Eric Leach , PA-C

Physician Assistant

NPI 1124068739

Physician Assistant (Certified)

Dr. Toby Johnson , MD

Orthopaedic Surgery - Hand Surgery

NPI 1144203258

Doctor of Medicine (M.D.)

Career & Practice History Timeline

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

6 Historical Events

✅

NPI Profile Active January 11, 2010

NPI status registered as active in NPPES database

📍

Updated Practice Location January 11, 2010

Registered at 1055 N 500 W, SUITE 121, PROVO, UT 846043305 (Tel: 8013737350)

📍

Updated Business Mailing Address January 11, 2010

Registered at 1055 N 500 W, CREDENTIALING DEPARTMENT, PROVO, UT 846043305 (Tel: 8014298000)

👤

Provider Name / Credentials Updated January 11, 2010

Recorded as JEFFREY WALLENTINE, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) January 11, 2010

Orthopaedic Surgery (License #356423-1205 in UT)

🟢

Initial NPI Registration & Enumeration September 07, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1124121934

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: September 07, 2006

Last Update: November 27, 2023

Sole Proprietor: No

Update or Correct Profile

Mailing Address

1055 N 500 W, Credentialing Department

Provo, UT 846043305

Phone: 8013548225

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.