DR. MICHAEL C. WALLIS (M.D.) – Urology Physician, NPI 1558384388
Urology Physician
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
279 PEDIATRIC MEDICINE in UT
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Provider Addresses for DR. MICHAEL C. WALLIS (M.D.)
PO BOX 413035
SALT LAKE CITY, UT 841413035
Phone: (801) 213-3900
Type: Mailing
Primary Children's Hospital, 100, Mario Capecchi Drive, Salt Lake City, Salt Lake County, Utah, 84113, United States
SALT LAKE CITY, UT 841131103
Phone: (801) 662-5555
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $73.
Total Amount is formed as General ($73) + Research ($0) + Ownership ($0) = $73.
Last reported payment date: 2023-11-06 • Largest payer in this snapshot: Boston Scientific Corporation ($52).
Total Amount
$73
General + Research + Ownership
Payments
2
Total payment records
General Amount
$73
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-11-06
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Boston Scientific Corporation | $52 |
| Medtronic, Inc. | $21 |
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: 2026-03-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
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 |
|---|---|---|---|---|
| I20070105000192 | I | Urology | UT | TBD |
| I20180125002054 | I | Pediatric Medicine | ID | TBD |
| I20260302003204 | I | Urology | MT | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 84141)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| N E U R O S U R G E R Y | UT | |
| Pediatric Medicine, Cardiovascular Disease (Cardiology) | UT | |
| Pediatric Medicine | UT | |
| - | UT | |
| - | UT | |
| - | OH | |
| - | UT | |
| - | UT | |
| - | UT | |
| - | UT |
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