JAKE TYLER WALLIS – Physical Therapist, NPI 1235682238
Physical Therapist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
835 PHYSICAL THERAPIST IN PRIVATE PRACTICE in AR
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Provider Addresses for JAKE TYLER WALLIS
2100 W MAIN ST
RUSSELLVILLE, AR 728012758
Phone: (479) 968-2525
Fax: (479) 968-2539
Type: Mailing
1630, Arden Lane, Conway, Faulkner County, Arkansas, 72034, United States
CONWAY, AR 720343543
Phone: (501) 477-2202
Fax: (501) 421-0543
Type: Mailing
100 WALMART DR STE 5
MORRILTON, AR 721104525
Phone: (501) 477-2202
Fax: (501) 421-0543
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2016-09-27
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20160927000449 | I | Physical Therapist In Private Practice | AR | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 2,286 | 189 | $0 |
| G0283 | Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care | 526 | 104 | $0 |
| 97140 | Therapy procedure using manual technique, each 15 minutes | 514 | 125 | $0 |
| 97530 | Therapy procedure using functional activities | 458 | 69 | $0 |
| 97112 | Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | 424 | 84 | $0 |
Insurance plans in this area (ZIP 72801)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | AR | |
| Physical Therapist In Private Practice | AR | |
| Physical Therapist In Private Practice | AR | |
| Physical Therapist In Private Practice | AR | |
| - | AR | |
| Physical Therapist In Private Practice | AR | |
| Physical Therapist In Private Practice | AR | |
| Physical Therapist In Private Practice | AR | |
| Physical Therapist In Private Practice | AR | |
| Physical Therapist In Private Practice | AR |
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