JACQUELYN M. SIMONIS M.D.
NPI 1548657703
Emergency Medicine in Salt Lake City, UT
About Jacquelyn M. Simonis M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACQUELYN M. SIMONIS M.D. (NPI 1548657703) is an individual emergency medicine provider in Salt Lake City, Utah, licensed in Utah (11849354-1205) and active in the NPI registry since April 2015. She is enrolled in Medicare PECOS, is affiliated with Gallup Indian Medical Center, and maintains a secondary practice location in Charlotte.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Jacquelyn M. Simonis M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Jacquelyn Simonis reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Salt Lake City, UT 84132
- Reassigned Medicare billing, Utah enrollment
- 2,620 clinicians in this Medicare group
Tohatchi, NM 87325
- Reassigned Medicare billing, Texas enrollment
- 618 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 2
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Gallup Indian Medical Center
Acute Care Hospitals · Gallup, NMPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 84132 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SALT LAKE CITY, UT 84132
SALT LAKE CITY, UT 84132
SALT LAKE CITY, UT 84132
SALT LAKE CITY, UT 84132
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 Jacquelyn Simonis's NPI number?
The NPI number for Jacquelyn Simonis is 1548657703. It was assigned to this individual provider in the NPPES registry on April 24, 2015.
Where is Jacquelyn Simonis located?
Jacquelyn Simonis practices at 30 N 1900 E Rm 4c104, Salt Lake City, UT 84132. The listed phone number is (801) 585-1686.
What is Jacquelyn Simonis's specialty?
The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.
Is Jacquelyn Simonis enrolled in Medicare?
Yes. Jacquelyn Simonis is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Jacquelyn Simonis's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jacquelyn Simonis reassigns Medicare benefits to 2 organizations: University Of Utah Adult Services (Salt Lake City, UT) and Dhhs, Phs, Naihs, Gallup Indian Medical Center (Tohatchi, NM). Each 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 Jacquelyn Simonis's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Jacquelyn Simonis affiliated with any hospitals?
According to CMS data, Jacquelyn Simonis is affiliated with Gallup Indian Medical Center.
When was this NPI record last updated?
The NPPES record for Jacquelyn Simonis was last updated on December 20, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Jacquelyn M. Simonis, M.D. · NPI 1548657703
Emergency Medicine physician in Salt Lake City, Utah. Individual provider, active in the CMS NPPES registry since April 24, 2015.
## Identity
- **NPI:** 1548657703 (Entity type: Individual)
- **Enumerated:** April 24, 2015
- **Primary specialty:** Emergency Medicine · taxonomy 207P00000X
- **State license:** 11849354-1205 (Utah)
- **Sole proprietor:** No
## Practice location
- **Address:** 30 N 1900 E RM 4C104, Salt Lake City, UT 84132-0002
- **Phone:** (801) 585-1686
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): University Of Utah Adult Services (NPI 1093119893, Salt Lake City, UT); Dhhs, Phs, Naihs, Gallup Indian Medical Center (NPI 1902875594, Tohatchi, NM) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of Utah School Of Medicine, class of 2015
## Record status
- **NPPES last updated:** December 20, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1548657703) · Data from the CMS NPPES public registry.