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JACOB WALLACE A.P.R.N
NPI 1639915911
Nurse Practitioner - Family in Logan, UT

Active since July 05, 2024PECOS EnrolledAccepts Medicare Assignment
630 E 1400 N STE 135, LOGAN, UT 84341(435) 787-8146(435) 787-8149 Get Directions Write a Review

NPPES record last updated: August 23, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 23, 2024, Jul 5, 2024 (2 updates tracked since 2024).

About Jacob Wallace A.p.r.n NPPES

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

JACOB WALLACE A.P.R.N (NPI 1639915911) is an individual family provider in Logan, Utah, licensed in Utah (7205712-4405) and active in the NPI registry since July 2024. He is enrolled in Medicare PECOS, is affiliated with Logan Regional Hospital, and is a graduate of Other (2024).

NPPES Registry Identity

NPI1639915911
Entity TypeIndividualMale
Primary Taxonomy363LF0000X
Provider Legal NameJACOB WALLACECredential: A.P.R.N
Location Address630 E 1400 N STE 135Logan, UT 84341-2549
Mailing AddressPo Box 912042St George, UT 84791-2042 · (435) 215-0230 · Fax (435) 986-7092
Phone(435) 787-8146
Fax(435) 787-8149
Sole ProprietorYes
Medical School CMSOtherGraduated 2024
Enumeration DateJuly 5, 2024
Last NPPES UpdateAugust 23, 20242 updates tracked since enumeration
NPPES CertifiedAugust 23, 2024
✔ NPI 1639915911 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in UT · 7205712-4405
Also ListedNurse Practitioner · GerontologyTaxonomy 363LG0600X · License 7205712-4405 (UT)
630 E 1400 N STE 135, Logan, UT 84341
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Molina Healthcare, Regence BlueCross BlueShield of Utah and more.Insurance ›

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

Jacob Wallace A.p.r.n 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 ID4688113285
PECOS Enrollment IDI20240827003897
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 3

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.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
85 services64 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
82 services65 patients
Testing for presence of drug, read by direct observation 80305
Testing for the presence of drugs involves collecting a sample, usually urine, which is then analyzed for specific substances. The process is monitored directly to ensure accuracy and integrity. This test helps to confirm if drugs are present in your system.
13 services13 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Logan Regional Hospital

Acute Care Hospitals · Logan, UT
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number460015
Location1400 North 500 EastLogan, UT 84341 · Cache County
Emergency services Birthing friendly

Bear River Valley Hospital

Acute Care Hospitals · Tremonton, UT
OwnershipVoluntary non-profit - Private
CMS Certification Number460039
Location905 North 1000 WestTremonton, UT 84337 · Box Elder County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84341 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 4

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

DR. BRIAN FARLEY RICHARDSON MD
Pain Medicine (Interventional Pain Medicine)
630 E 1400 N STE 135
LOGAN, UT 84341
Cache County (435) 787-8146
JOHN GILES
Physician Assistant
630 E 1400 N STE 135
LOGAN, UT 84341
Cache County (435) 787-8146
MARK DANIEL SABIN DO
Pain Medicine (Interventional Pain Medicine)
630 E 1400 N STE 135
LOGAN, UT 84341
Cache County (435) 787-8146
MR. MATTHEW R HARVEY NP-C
Nurse Practitioner (Gerontology)
630 E 1400 N STE 135
LOGAN, UT 84341
Cache County (435) 787-8146

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 Jacob Wallace's NPI number?

The NPI number for Jacob Wallace is 1639915911. It was assigned to this individual provider in the NPPES registry on July 5, 2024.

Where is Jacob Wallace located?

Jacob Wallace practices at 630 E 1400 N Ste 135, Logan, UT 84341. The listed phone number is (435) 787-8146.

What is Jacob Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Jacob Wallace enrolled in Medicare?

Yes. Jacob Wallace 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.

What insurance does Jacob Wallace accept?

Health plans from BridgeSpan Health Company, Molina Healthcare, Regence BlueCross BlueShield of Utah, Select Health and University of Utah Health Plans list Jacob Wallace 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.

Is Jacob Wallace affiliated with any hospitals?

According to CMS data, Jacob Wallace is affiliated with Logan Regional Hospital and Bear River Valley Hospital.

When was this NPI record last updated?

The NPPES record for Jacob Wallace was last updated on August 23, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months 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.