Benjamin Pantone Wallace, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

1160 E 3900 S Ste 3500
Salt Lake City, UT 84124-1264

Phone

(801) 476-6900

NPI assigned

Aug 6, 2009

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

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountainstar Cardiovascular Services LLCGroup PAC ID 1951404110, 14 clinicians

Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health McKay-Dee Hospital Hospital, Ogden, UT, CCN 460004
• St Mark'S Hospital Hospital, Salt Lake City, UT, CCN 460047

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Mountainstar Cardiovascular Services LLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Salt Lake City, UT
  • NPI 1689721219
  Medicare reassignment Care Compare group NPD
• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Sandy, UT
  • NPI 1942325154
  Medicare reassignment Care Compare group
• Ihc Health Services Inc

  • Pediatric Critical Care Medicine Physician
  • Provo, UT
  • NPI 1174039614
  NPD
• Ihc Health Services, Inc.

  • Psychiatry Physician
  • St George, UT
  • NPI 1023843844
  NPD
• Ihc Health Services Inc

  • Family Medicine Physician
  • Salt Lake City, UT
  • NPI 1306888722
  NPD (past)
• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Orem, UT
  • NPI 1588601124
  NPD (past)
• Ihc Health Services Inc

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Ogden, UT
  • NPI 1962547695
  NPD (past)
• Mountainstar Cardiology St Marks LLC

  • Interventional Cardiology Physician
  • Salt Lake City, UT
  • NPI 1437446168
  NPD (past)
• Firstcare Medical Foundation

  • Family Medicine Physician
  • Albany, OR
  • NPI 1740216498
  NPD (past)
• Good Samaritan Hospital Corvallis

  • Durable Medical Equipment & Medical Supplies
  • Corvallis, OR
  • NPI 1477851186
  NPD (past)

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

• Ihc Health Services Inc

  • General Acute Care Hospital
  • Ogden, UT
  • NPI 1194749580
  Care Compare affiliation
• Northern Utah Healthcare Corporation

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1164469243
  Care Compare affiliation

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

{
    "created_epoch": "1249516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767312000000",
    "number": "1992936066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 281490",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303841490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 E 3900 S STE 3500",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241264",
            "telephone_number": "801-476-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BENJAMIN",
        "middle_name": "PANTONE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-06",
        "last_updated": "2026-01-02",
        "certification_date": "2026-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terry Wall
• Travis Scott Wall, MD
• Wallace Stegner Academy
• Christopher Lucciano Wallace-Carrete
• Ann Elizabeth Wallace, OTR/L
• Cameron W. Wallace, MD
• Chiara Wallace
• Connor Wallace
• Diane Elizabeth Wallace, R.PH.
• Jacob Wallace

• Surgical Physician Assistant in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Surgical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2026; 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.