Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Benjamin Pantone Wallace, PA

Individual provider Surgical Physician Assistant · NPI 1992936066

Benjamin Pantone Wallace, PA is a Physician Assistant in Salt Lake City, Utah. Qualified in 2009, 17 years ago. Practices with Mountainstar Cardiovascular Services LLC, a 14-clinician group and accepts Medicare assignment.

Years since qualifying
17
In the registry since
2009
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1160 E 3900 S Ste 3500
Salt Lake City, UT 84124-1264
Phone: (801) 476-6900
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X

Record details

NPI number1992936066
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedAugust 6, 2009
Last updated in NPPESJanuary 2, 2026
Certification dateJanuary 2, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice Mountainstar Cardiovascular Services Llc — 14 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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