DR. JONATHAN PETER BOLTAX (MD) – Internal Medicine Physician, NPI 1629023692
Internal Medicine Physician
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
15 PULMONARY DISEASE in WY
Provider Addresses for DR. JONATHAN PETER BOLTAX (MD)
555 E BROADWAY AVE STE 220
JACKSON, WY 830018640
Phone: (307) 739-7305
Fax: (307) 739-4960
Type: Location
324, 10th Avenue, Greater Avenues, Salt Lake City, Salt Lake County, Utah, 84103, United States
SALT LAKE CITY, UT 841032892
Phone: (801) 535-7029
Fax: (801) 535-7034
Type: Mailing
PO BOX 428
JACKSON, WY 830010428
Phone: (307) 739-7305
Fax: (307) 739-4960
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $90.
Total Amount is formed as General ($90) + Research ($0) + Ownership ($0) = $90.
Last reported payment date: 2024-08-20 • Largest payer in this snapshot: SANOFI-AVENTIS U.S. LLC ($90).
Total Amount
$90
General + Research + Ownership
Payments
1
Total payment records
General Amount
$90
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-20
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| SANOFI-AVENTIS U.S. LLC | $90 |
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: 2015-03-24
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 |
|---|---|---|---|---|
| I20150324002473 | I | Pulmonary Disease | WY | 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 |
|---|---|---|---|---|
| 94727 | Test to determine lung volumes using gas dilution or washout | 354 | 337 | $0 |
| 94729 | Test to examine how well the lungs exchange gases | 352 | 335 | $0 |
| 94010 | Test to measure expiratory airflow and volume | 342 | 303 | $0 |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 67 | 20 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 56 | 53 | $0 |
Insurance plans in this area (ZIP 83001)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PULMONARY DISEASE | UT | 31500 | Emergent insertion of breathing tube into windpipe cartilage using an endoscope | 12 | 12 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Emergency Medicine | WY | |
| - | WY | |
| - | WY | |
| Physician Assistant | WY | |
| - | WY | |
| Certified Registered Nurse Anesthetist (Crna) | WY | |
| General Surgery | WY | |
| Physician Assistant | UT | |
| General Surgery | ID | |
| Qualified Audiologist | WY |
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