JACQUELYN M. SIMONIS M.D.
NPI 1548657703
Emergency Medicine in Salt Lake City, UT

Active since April 24, 2015PECOS EnrolledAccepts Medicare Assignment
30 N 1900 E RM 4C104, SALT LAKE CITY, UT 84132(801) 585-1686 Get Directions Write a Review

NPPES record last updated: December 20, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Dec 20, 2021, Nov 9, 2021, May 26, 2021 (3 updates tracked since 2021).

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

NPI1548657703
Entity TypeIndividualFemale
Primary Taxonomy207P00000X
Provider Legal NameJACQUELYN M. SIMONISCredential: M.D.
Location Address30 N 1900 E RM 4C104Salt Lake City, UT 84132-0002
Mailing Address30 N 1900 E Rm 4c104Salt Lake City, UT 84132-0002 · (801) 585-1686
Sole ProprietorNo
Medical School CMSUniversity Of Utah School Of MedicineGraduated 2015
Enumeration DateApril 24, 2015
Last NPPES UpdateDecember 20, 20213 updates tracked since enumeration
NPPES CertifiedDecember 20, 2021
NPI 1548657703 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
Licenses Licensed in UT · 11849354-1205 Licensed in NC · 209357
Definition

An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.

Also ListedInternal Medicine · Hospice and Palliative MedicineTaxonomy 207RH0002X · License 11849354-1205 (UT)
30 N 1900 E RM 4C104, Salt Lake City, UT 84132

Secondary Practice Location 1

Location 11000 Blythe BlvdCharlotte, NC 28203-5812 · Phone (704) 446-9253

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

PECOS PAC ID840568796
PECOS Enrollment IDI20191024000461
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.

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.

Emergency department visit with low level of medical decision making 99283
An emergency department visit for a problem of moderate severity involves immediate medical attention for issues like minor fractures, burns, or high fever. The healthcare team will assess your condition, provide necessary treatment, and may suggest further tests or admission if required.
18 services18 patients
Emergency department visit with moderate level of medical decision making 99284
An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
17 services17 patients

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, NM
2/5 CMS rating
OwnershipGovernment - Federal
CMS Certification Number320061
Location516 E Nizhoni BlvdGallup, NM 87301 · Mckinley County
Emergency services Birthing friendly

Physician 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.

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 20

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

Internal Medicine
30 N 1900 E RM 4C104
SALT LAKE CITY, UT 84132
Student in an Organized Health Care Education/Training Program
30 N 1900 E RM 4C104
SALT LAKE CITY, UT 84132
Internal Medicine
30 N 1900 E RM 4C104
SALT LAKE CITY, UT 84132
Internal Medicine
30 N 1900 E RM 4C104
SALT LAKE CITY, UT 84132
Internal Medicine
30 N 1900 E RM 4C104
SALT LAKE CITY, UT 84132
Internal Medicine (Hospice and Palliative Medicine)
30 N 1900 E RM 4C104
SALT LAKE CITY, UT 84132
Internal Medicine (Hospice and Palliative Medicine)
30 N 1900 E RM 4C104
SALT LAKE CITY, UT 84132
Internal Medicine
30 N 1900 E RM 4C104
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.

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 with the weekly NPPES data releases published by CMS.