Jeffrey M Wallentine, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

356423-1205 Issued in UT

Practice address

1055 N 500 W
Suite 121
Provo, UT 84604-3305

Phone

(801) 373-7350

Fax

(801) 812-5401

NPI assigned

Sep 7, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 8

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Orthopedic Surgery

Education

University of Utah School of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Revere Health PCGroup PAC ID 7517868508, 407 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Aspen Ridge Home Health Home health agency, Murray, UT, CCN 467220
• Canyon Home Care Home health agency, Murray, UT, CCN 467226
• At Home Health Care Home health agency, Salina, UT, CCN 467112
• Symbii Home Health South Home health agency, Murray, UT, CCN 467342
• Mountain View Hospital Hospital, Payson, UT, CCN 460013
• Intermountain Health Spanish Fork Hospital Hospital, Spanish Fork, UT, CCN 460062
• Intermountain Health Sanpete Valley Hospital Hospital, Mount Pleasant, UT, CCN 461303
• Timpanogos Regional Hospital Hospital, Orem, UT, CCN 460052
• Intermountain Health Utah Valley Hospital Hospital, Provo, UT, CCN 460001

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• UT PPO D-SNP
• UT PPO

Interoperability endpoints

• Direct secure messaging: jeffreywallentine@cuccu.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Revere Health PC

  • Multi-Specialty Clinic/Center
  • Provo, UT
  • NPI 1093764805
  Medicare reassignment Care Compare group NPD
• Revere Health PC

  • Multi-Specialty Clinic/Center
  • Spanish Fork, UT
  • NPI 1851142285
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ahc Home Health Care of Murray, LLC

  • Home Health Agency
  • Murray, UT
  • NPI 1184778607
  Care Compare affiliation
• At Home Health Care Service Inc

  • Home Health Agency
  • Salina, UT
  • NPI 1700908274
  Care Compare affiliation
• Exemplar Healthcare, Inc.

  • Home Health Agency
  • Murray, UT
  • NPI 1164901484
  Care Compare affiliation
• Home Caregivers Partnership, LLC

  • Home Health Agency
  • Murray, UT
  • NPI 1306899265
  Care Compare affiliation
• Ihc Health Services, Inc.

  • General Acute Care Hospital
  • Provo, UT
  • NPI 1114025491
  Care Compare affiliation
• Ihc Health Services, Inc.

  • General Acute Care Hospital
  • Spanish Fork, UT
  • NPI 1124661384
  Care Compare affiliation
• Ihc Health Services, Inc.

  • Critical Access Hospital
  • Mt Pleasant, UT
  • NPI 1407964398
  Care Compare affiliation
• Ihc Health Services, Inc.

  • Infusion Therapy Clinic/Center
  • Spanish Fork, UT
  • NPI 1679426944

  Hospital

  Care Compare affiliation
• Ihc Health Services, Inc.

  • Infusion Therapy Clinic/Center
  • American Fork, UT
  • NPI 1982557252

  Hospital

  Care Compare affiliation
• Mountain View Hospital, Inc.

  • General Acute Care Hospital
  • Payson, UT
  • NPI 1487607669
  Care Compare affiliation
• Timpanogos Regional Medical Services, Inc.

  • General Acute Care Hospital
  • Orem, UT
  • NPI 1497702195
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1124121934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "CREDENTIALING DEPARTMENT",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "SUITE 121",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-373-7350",
            "fax_number": "801-812-5401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 W 800 N Ste 100",
            "address_purpose": "LOCATION",
            "city": "Orem",
            "state": "UT",
            "postal_code": "840576301",
            "country_code": "US",
            "telephone_number": "801-373-7350",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "65 E 100 N",
            "address_2": "Ste A",
            "address_purpose": "LOCATION",
            "city": "Gunnison",
            "state": "UT",
            "postal_code": "84634",
            "country_code": "US",
            "telephone_number": "801-373-7350",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 S Medical Dr",
            "address_purpose": "LOCATION",
            "city": "MT Pleasant",
            "state": "UT",
            "postal_code": "846472222",
            "country_code": "US",
            "telephone_number": "801-373-7350",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "555 W SR 164",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "UT",
            "postal_code": "84653",
            "country_code": "US",
            "telephone_number": "801-373-7350",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1130 Smith Fieldhouse",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846022246",
            "country_code": "US",
            "telephone_number": "801-373-7350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLENTINE",
        "first_name": "JEFFREY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2023-11-27",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "UT",
            "license": "356423-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHC",
            "identifier": "107008449102",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "68080",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UTAH HEALTHCARE",
            "identifier": "09-00180",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "344490",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870281028000",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS",
            "identifier": "QM000056640",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO",
            "identifier": "200045124",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMIA",
            "identifier": "870281028WAL",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Revere Health PC",
            "address_1": "1055 N 500 W",
            "address_2": "Suite 121",
            "city": "Provo",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846043305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nicole Walker
• Scott Walker, DO
• Verdon Reed Walker III, PA
• Brenna Mackenzie Wall
• Tauheedah Sabreen Wallace, MSSW-MFT, LAMFT
• McKenna Wallentine, LCSW
• Steven L Wallentine, MD
• Kalley Marie Waller, PSYD
• Walmart Inc.
• Amanda Walser

• Orthopaedic Surgery Physician in Provo, UT
• Providers in Provo, UT by specialty
• Orthopaedic Surgery Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.