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DR. MICHAEL C. WALLIS M.D.
NPI 1558384388
Urology in Salt Lake City, UT

Active since July 25, 2006PECOS EnrolledAccepts Medicare Assignment
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113(801) 662-5555 Get Directions Write a Review

NPPES record last updated: December 16, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 16, 2021, Jun 4, 2020 (2 updates tracked since 2020).

About Dr. Michael C. Wallis M.d. NPPES

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

DR. MICHAEL C. WALLIS M.D. (NPI 1558384388) is an individual urology provider in Salt Lake City, Utah, licensed in Utah (6078212-1205) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS and is a graduate of Ohio State University College Of Medicine (1999).

NPPES Registry Identity

NPI1558384388
Entity TypeIndividualMale
Primary Taxonomy208800000X
Provider Legal NameDR. MICHAEL C. WALLISCredential: M.D.
Location Address100 MARIO CAPECCHI DRSalt Lake City, UT 84113-1103
Mailing AddressPo Box 413035Salt Lake City, UT 84141-3035 · (801) 213-3900
Phone(801) 662-5555
Sole ProprietorNo
Medical School CMSOhio State University College Of MedicineGraduated 1999
Enumeration DateJuly 25, 2006
Last NPPES UpdateDecember 16, 20212 updates tracked since enumeration
NPPES CertifiedDecember 16, 2021
✔ NPI 1558384388 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyUrologyAllopathic & Osteopathic Physicians
Taxonomy Code208800000X
License✔ Licensed in UT · 6078212-1205
Definition
A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.
Also ListedUrology · Pediatric UrologyTaxonomy 2088P0231X · License M-13870 (ID)
100 MARIO CAPECCHI DR, Salt Lake City, UT 84113
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, BridgeSpan Health Company, Moda Health Plan, Inc. and more.Insurance ›

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

Dr. Michael C. Wallis 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 ID6406856046
PECOS Enrollment IDI20070105000192, I20180125002054
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 Reassignments

4

Medicare enrollment records show Michael Wallis reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Ihc Health Services Inc
Same address
Pediatrics
100 N MARIO CAPECCHI DR
Salt Lake City, UT 84113
  • Reassigned Medicare billing, Utah enrollment
  • 1,729 clinicians in this Medicare group
NPI 1003255464 (801) 662-1000
University Of Utah Pediatric Services
Same address
Electrodiagnostic Medicine
100 N MARIO CAPECCHI DR
Salt Lake City, UT 84113
  • Reassigned Medicare billing, Idaho and Utah enrollments
  • Also billed through NPI 1063876100 (Utah)
  • 12 clinicians in this Medicare group
NPI 1336503812 (801) 587-6336
University Of Utah Adult Services
Same address
Anesthesiology
30 N 1900 E, 3C 444
Salt Lake City, UT 84132
  • Reassigned Medicare billing, Utah enrollment
  • 2,620 clinicians in this Medicare group
NPI 1720482599 (801) 587-6336
Scl Health Medical Group - Billings LLC
349 mi
Rural Health
55 N MONTANA AVE
Absarokee, MT 59001
  • Reassigned Medicare billing, Montana enrollment
  • 438 clinicians in this Medicare group
NPI 1649883539 (406) 328-4497

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 84113 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
$125.70 typical visit price
range $54.34 – $166.03
Typical copayment $31.42 (range $13.58 – $41.50)
Most-billed visit code 99204
Established Patient
$68.01 typical visit price
range $17.23 – $135.20
Typical copayment $17.00 (range $4.30 – $33.80)
Most-billed visit code 99213
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.

KAITLIN CARPENTER
Pediatrics
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 662-1000
DR. NICOLE JEFFREYS MD
Anesthesiology (Pediatric Anesthesiology)
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 662-3578
SARAH ZOBELL NP
Nurse Practitioner (Pediatrics)
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 662-1619
MRS. GIOVANA MARTENDAL KING NNP-BC
Nurse Practitioner (Neonatal, Critical Care)
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 662-4100
DR. STEVEN SHI-FONG WU
Pediatrics (Pediatric Gastroenterology)
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 662-2900
KRISTA SKYE VIAU MS, RD, CSP, CD
Dietitian, Registered (Nutrition, Metabolic)
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 587-9590
DR. ANDREW GERALD SMITH M.D.
Pediatrics (Pediatric Critical Care Medicine)
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 662-3673
MARY HUNT MARTIN MD
Pediatrics (Pediatric Cardiology)
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 662-5400

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 Michael Wallis's NPI number?

The NPI number for Michael Wallis is 1558384388. It was assigned to this individual provider in the NPPES registry on July 25, 2006.

Where is Michael Wallis located?

Michael Wallis practices at 100 Mario Capecchi Dr, Salt Lake City, UT 84113. The listed phone number is (801) 662-5555.

What is Michael Wallis's specialty?

The primary specialty registered for this NPI is Urology with taxonomy code 208800000X.

Is Michael Wallis enrolled in Medicare?

Yes. Michael Wallis 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 Michael Wallis's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Michael Wallis reassigns Medicare benefits to 4 organizations: Ihc Health Services Inc (Salt Lake City, UT), University Of Utah Pediatric Services (Salt Lake City, UT), University Of Utah Adult Services (Salt Lake City, UT) and Scl Health Medical Group - Billings LLC (Absarokee, MT). 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 Michael Wallis's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Michael Wallis accept?

Health plans from Blue Cross and Blue Shield of Montana, BridgeSpan Health Company, Moda Health Plan, Inc., Molina Healthcare and PacificSource Health Plans and 4 other insurers list Michael Wallis as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Michael Wallis was last updated on December 16, 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.