STACEY MILLS LAKE NP
NPI 1154003473
Nurse Practitioner - Primary Care in Holladay, UT

Active since August 04, 2023PECOS EnrolledAccepts Medicare Assignment
999 E MURRAY HOLLADAY RD STE 207, HOLLADAY, UT 84117(801) 268-2584 Get Directions Write a Review

NPPES record last updated: January 22, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Stacey Mills Lake Np NPPES

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

STACEY MILLS LAKE NP (NPI 1154003473) is an individual primary care provider in Holladay, Utah, licensed in Utah (5641317-4405) and active in the NPI registry since August 2023. She is enrolled in Medicare PECOS, is affiliated with St Mark's Hospital, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1154003473
Entity TypeIndividualFemale
Primary Taxonomy363LP2300X
Provider Legal NameSTACEY MILLS LAKECredential: NP
Location Address999 E MURRAY HOLLADAY RD STE 207Holladay, UT 84117-5093
Mailing Address2965 W 3500 SWest Valley City, UT 84119-3602 · (801) 965-3600
Sole ProprietorNo
Medical School CMSOtherGraduated 2023
Enumeration DateAugust 4, 2023
Last NPPES UpdateJanuary 22, 2025
NPPES CertifiedJanuary 22, 2025
NPI 1154003473 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
License Licensed in UT · 5641317-4405
Also ListedNurse PractitionerTaxonomy 363L00000X · License 5641317-4405 (UT)
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License 5641317-4405 (UT)
999 E MURRAY HOLLADAY RD STE 207, Holladay, UT 84117

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Stacey Mills Lake Np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID749643039
PECOS Enrollment IDI20230905001693
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.

Areas of Expertise CMS Part B claims 8

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
74 services39 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
51 services39 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
35 services35 patients
Annual depression screening, 5 to 15 minutes G0444
An annual depression screening is a short, routine evaluation to check for signs of depression. It involves answering a series of questions about your feelings, thoughts, and behaviors. The process takes about 15 minutes and helps detect depression early for better management.
29 services29 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
13 services13 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
13 services13 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Mark's Hospital

Acute Care Hospitals · Salt Lake City, UT
3/5 CMS rating
OwnershipProprietary
CMS Certification Number460047
Location1200 East 3900 SouthSalt Lake City, UT 84124 · Salt Lake County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84117 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.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Internal Medicine (Rheumatology)
999 E MURRAY HOLLADAY RD STE 207
MILLCREEK, UT 84117
Family Medicine
999 E MURRAY HOLLADAY RD STE 207
MILLCREEK, UT 84117
Family Medicine
999 E MURRAY HOLLADAY RD STE 207
HOLLADAY, UT 84117

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 Stacey Lake's NPI number?

The NPI number for Stacey Lake is 1154003473. It was assigned to this individual provider in the NPPES registry on August 4, 2023.

Where is Stacey Lake located?

Stacey Lake practices at 999 E Murray Holladay Rd Ste 207, Holladay, UT 84117. The listed phone number is (801) 268-2584.

What is Stacey Lake's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Is Stacey Lake enrolled in Medicare?

Yes. Stacey Lake is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Stacey Lake accept?

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

Is Stacey Lake affiliated with any hospitals?

According to CMS data, Stacey Lake is affiliated with St Mark's Hospital.

When was this NPI record last updated?

The NPPES record for Stacey Lake was last updated on January 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.