Individual provider Active NPI

Jesse Walker, DO

  • Physical Medicine & Rehabilitation Physician
  • Sandy, UT
National Provider Identifier
1417452046
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
11420247-1204 Issued in UT
Practice address
8074 S 1300 E
Sandy, UT 84094-0743
Phone
(925) 330-5535
NPI assigned
Mar 26, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 11420247-1204 UT Primary

Addresses

Primary practice location

8074 S 1300 E
Sandy, UT 84094-0743

Mailing address

1611 E Spring Run Dr
Holladay, UT 84117-6956
Phone (925) 330-5535

Other practice location 1

30 N 1900 E
Salt Lake City, UT 84132-0002
Phone (801) 581-7985

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20220721000928 UT Practitioner - Physical Medicine and Rehabilitation 5991138794 Reassigns benefits to 3 organizations
Practice locations: Sandy, UT

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Redrockrehab PLLCGroup PAC ID 8628514890, 9 clinicians

Practice addresses (Care Compare)

8074 S 1300
Sandy, UT 84094-0743
Phone (801) 561-3400

Hospital & facility affiliations

  • First Choice Hospice Hospice, Orem, UT, CCN 461549
  • Encompass Health Rehabilitation Hospital of Utah Inpatient rehabilitation facility, Sandy, UT, CCN 463025

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Claris Health PLLC CurrentSince May 24, 2022 Accepting new patients
Redrockrehab PLLC Physical Medicine & Rehabilitation CurrentSince Jul 1, 2024 Accepting new patients
Jesse Walker DO PLLC Physical Medicine & Rehabilitation CurrentSince Feb 16, 2023 Accepting new patients
Forward Medical PC PastSince Mar 20, 2025 Accepting new patients

Locations

560 W 465 N
Ste 604
Providence, UT 84332
Phone (435) 753-1600

8074 S 1300 E
Sandy, UT 84094
Phone (801) 561-3400

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658880000000",
    "number": "1417452046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 E SPRING RUN DR",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841176956",
            "telephone_number": "925-330-5535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8074 S 1300 E",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840940743",
            "telephone_number": "925-330-5535"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30 N 1900 E",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841320002",
            "country_code": "US",
            "telephone_number": "801-581-7985",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALKER",
        "first_name": "JESSE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-26",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "UT",
            "license": "11420247-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandy, UT

Sources for this page

Verify at the official NPI Registry.