STACEY MILLS LAKE NP
NPI 1154003473
Nurse Practitioner - Primary Care in Holladay, UT
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
Specialties & Licenses 3
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
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.
Medicare Billing Reassignments
2Medicare enrollment records show Stacey Lake reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Salt Lake City, UT 84107
- Reassigned Medicare billing, Utah enrollment
- 190 clinicians in this Medicare group
West Valley City, UT 84119
- Reassigned Medicare billing, Utah enrollment
- 188 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
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, UTPhysician 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.
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.
MILLCREEK, 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.
Which organizations bill Medicare for Stacey Lake's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Stacey Lake reassigns Medicare benefits to 2 organizations: Granger Medical Clinic PC (Salt Lake City, UT) and Granger Medical Specialists LLC (West Valley City, UT). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Stacey Lake's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
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 21 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.
# Stacey Mills Lake, NP · NPI 1154003473
Primary Care physician in Holladay, Utah. Individual provider, active in the CMS NPPES registry since August 4, 2023.
## Identity
- **NPI:** 1154003473 (Entity type: Individual)
- **Enumerated:** August 4, 2023
- **Primary specialty:** Nurse Practitioner - Primary Care · taxonomy 363LP2300X
- **State license:** 5641317-4405 (Utah)
- **Sole proprietor:** No
## Practice location
- **Address:** 999 E MURRAY HOLLADAY RD STE 207, Holladay, UT 84117-5093
- **Phone:** (801) 268-2584
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Granger Medical Clinic PC (NPI 1356425672, Salt Lake City, UT); Granger Medical Specialists LLC (NPI 1376159368, West Valley City, UT) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2023
## Record status
- **NPPES last updated:** January 22, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1154003473) · Data from the CMS NPPES public registry.