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WISE CLEFT CENTER FOR EXCELLENCE LLC
NPI 1588407142
Plastic Surgery in Draper, UT

Active since June 13, 2024
11762 S STATE ST STE 110, DRAPER, UT 84020(385) 977-8125 Get Directions Write a Review

NPPES record last updated: February 20, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Feb 20, 2025, Jun 13, 2024 (2 updates tracked since 2024).

About Wise Cleft Center For Excellence Llc NPPES

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

WISE CLEFT CENTER FOR EXCELLENCE LLC (NPI 1588407142) is a healthcare organization registered as a plastic surgery in Draper, Utah and active in the NPI registry since June 2024. The organization lists Gavin Lawrence, Director Of Development, as its authorized official.

NPPES Registry Identity

NPI1588407142
Entity TypeOrganization
Primary Taxonomy208200000X
Legal Business NameWISE CLEFT CENTER FOR EXCELLENCE LLC
Location Address11762 S STATE ST STE 110Draper, UT 84020-7158
Mailing Address11762 S State St Ste 110Draper, UT 84020-7158 · (385) 218-0587 · Fax (385) 381-4447
Phone(385) 977-8125
Organization SubpartNo
Authorized OfficialGavin LawrenceDirector Of Development · (435) 669-7660
Enumeration DateJune 13, 2024
Last NPPES UpdateFebruary 20, 20252 updates tracked since enumeration
NPPES CertifiedFebruary 20, 2025
✔ NPI 1588407142 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPlastic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208200000X
Definition
A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.
11762 S STATE ST STE 110, Draper, UT 84020
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Regence BlueCross BlueShield of Utah, University of Utah Health Plans.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Wise Cleft Center For Excellence Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Wise Cleft Center For Excellence LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Devan Griner, MD
Plastic and Reconstructive Surgery
NPI 1780895755
11762 S STATE ST STE 110
Draper, UT 84020
(385) 218-0587
✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Wise Cleft Center For Excellence LLC's NPI number?

The NPI number for Wise Cleft Center For Excellence LLC is 1588407142. It was assigned to this organization in the NPPES registry on June 13, 2024.

Where is Wise Cleft Center For Excellence LLC located?

Wise Cleft Center For Excellence LLC is located at 11762 S State St Ste 110, Draper, UT 84020. The listed phone number is (385) 977-8125.

What is Wise Cleft Center For Excellence LLC's specialty?

The primary specialty registered for this NPI is Plastic Surgery with taxonomy code 208200000X.

Is Wise Cleft Center For Excellence LLC enrolled in Medicare?

Yes. Wise Cleft Center For Excellence LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Wise Cleft Center For Excellence LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Plastic and Reconstructive Surgery) reassigns their Medicare billing to Wise Cleft Center For Excellence LLC. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Wise Cleft Center For Excellence LLC accept?

Health plans from BridgeSpan Health Company, Regence BlueCross BlueShield of Utah and University of Utah Health Plans list Wise Cleft Center For Excellence LLC 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.

When was this NPI record last updated?

The NPPES record for Wise Cleft Center For Excellence LLC was last updated on February 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 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.