1. Home
  2. Directory
  3. Utah
  4. Herriman
  5. Nurse Practitioner
  6. NPI Profile

BONNIE LEIGH WALLACE FNP-C
NPI 1871316372
Nurse Practitioner - Family in Herriman, UT

Active since November 04, 2024PECOS Enrolled
12573 S LIBERTY HILL CT, HERRIMAN, UT 84096(801) 690-4899 Get Directions Write a Review

NPPES record last updated: November 4, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Bonnie Leigh Wallace Fnp-c NPPES

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

BONNIE LEIGH WALLACE FNP-C (NPI 1871316372) is an individual family provider in Herriman, Utah, licensed in Utah (7682759-4405) and active in the NPI registry since November 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1871316372
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameBONNIE LEIGH WALLACECredential: FNP-C
Location Address12573 S LIBERTY HILL CTHerriman, UT 84096-7774
Mailing Address12573 S Liberty Hill CtHerriman, UT 84096-7774 · (801) 690-4899
Phone(801) 690-4899
Sole ProprietorYes
Medical School CMSOtherGraduated 2024
Enumeration DateNovember 4, 2024
NPPES CertifiedOctober 21, 2024
✔ NPI 1871316372 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in UT · 7682759-4405
12573 S LIBERTY HILL CT, Herriman, UT 84096
Open in Google Maps ↗

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, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Bonnie Leigh Wallace Fnp-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8527540442
PECOS Enrollment IDI20260228000766
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 Bonnie Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Utah Cancer Specialists PC
14 mi
Medical Oncology
3838 S 700 E STE 100
Salt Lake City, UT 84106
  • Reassigned Medicare billing, Utah enrollment
  • 57 clinicians in this Medicare group
NPI 1619925369 (801) 269-0231

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 84096 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.

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 Bonnie Wallace's NPI number?

The NPI number for Bonnie Wallace is 1871316372. It was assigned to this individual provider in the NPPES registry on November 4, 2024.

Where is Bonnie Wallace located?

Bonnie Wallace practices at 12573 S Liberty Hill Ct, Herriman, UT 84096. The listed phone number is (801) 690-4899.

What is Bonnie Wallace's specialty?

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

Is Bonnie Wallace enrolled in Medicare?

Yes. Bonnie Wallace is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Bonnie Wallace's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Bonnie Wallace reassigns Medicare benefits to Utah Cancer Specialists PC (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 Bonnie Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Bonnie Wallace accept?

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

When was this NPI record last updated?

The NPPES record for Bonnie Wallace was last updated on November 4, 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.