1. Home
  2. Directory
  3. Utah
  4. Salt Lake City
  5. Family Medicine
  6. NPI Profile

DR. JON T WALL MD
NPI 1528006491
Family Medicine in Salt Lake City, UT

Active since June 03, 2006PECOS Enrolled
4624 HOLLADAY BLVD, SALT LAKE CITY, UT 84117(801) 277-2682(801) 277-2980 Get Directions Write a Review

NPPES record last updated: June 1, 2009. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Jon T Wall Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JON T WALL MD (NPI 1528006491) is an individual family medicine provider in Salt Lake City, Utah, licensed in Utah (76-159863-1205) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1528006491
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDR. JON T WALLCredential: MD
Location Address4624 HOLLADAY BLVDSalt Lake City, UT 84117-5206
Mailing Address4624 Holladay BlvdSalt Lake City, UT 84117-5206 · (801) 277-2682 · Fax (801) 277-2980
Phone(801) 277-2682
Fax(801) 277-2980
Sole ProprietorNo
Enumeration DateJune 3, 2006
Last NPPES UpdateJune 1, 2009
✔ NPI 1528006491 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in UT · 76-159863-1205
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
4624 HOLLADAY BLVD, Salt Lake City, UT 84117
Open in Google Maps ↗

Other Identifiers 2

Medicare UPIND07861UT
Medicare PINU000005441UT

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jon T Wall Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jon Wall reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Olympus Clinic
Same address
Family Medicine
4624 S HOLLADAY BLVD STE 100
Salt Lake City, UT 84117
  • Reassigned Medicare billing, Utah enrollment
  • 14 clinicians in this Medicare group
NPI 1508810508 (801) 277-2682

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84117 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.41 typical visit price
range $54.34 – $166.03
Typical copayment $21.10 (range $13.58 – $41.50)
Most-billed visit code 99203
Established Patient
$96.35 typical visit price
range $17.23 – $135.20
Typical copayment $24.08 (range $4.30 – $33.80)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VICKI L JACKMAN APRN
Nurse Practitioner
4624 HOLLADAY BLVD
SALT LAKE CITY, UT 84117
Salt Lake County (801) 277-2682
JARED B PROBST MD
Family Medicine
4624 HOLLADAY BLVD
SALT LAKE CITY, UT 84117
Salt Lake County (801) 277-2682
STEVEN W HEATH MD
Family Medicine
4624 HOLLADAY BLVD
SALT LAKE CITY, UT 84117
Salt Lake County (801) 277-2682
CHRISTOPHER J GAMBLE MD
Family Medicine
4624 HOLLADAY BLVD
SALT LAKE CITY, UT 84117
Salt Lake County (801) 277-2682
DR. ROBERT J HILL JR. MD
Family Medicine
4624 HOLLADAY BLVD
SALT LAKE CITY, UT 84117
Salt Lake County (801) 277-2682

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jon Wall's NPI number?

The NPI number for Jon Wall is 1528006491. It was assigned to this individual provider in the NPPES registry on June 3, 2006.

Where is Jon Wall located?

Jon Wall practices at 4624 Holladay Blvd, Salt Lake City, UT 84117. The listed phone number is (801) 277-2682.

What is Jon Wall's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Jon Wall enrolled in Medicare?

Yes. Jon Wall is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jon Wall's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jon Wall reassigns Medicare benefits to Olympus Clinic (Salt Lake City, UT). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jon Wall's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jon Wall was last updated on June 1, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.