Stacey Mills Lake, NP in Holladay, UT - Medicare Nurse Practitioner

Stacey Mills Lake, NP is a medicare enrolled "Nurse Practitioner - Primary Care" in Holladay, Utah. Her current practice location is 999 E Murray Holladay Rd Ste 207, Holladay, Utah. You can reach out to her office (for appointments etc.) via phone at (801) 268-2584.

Stacey Mills Lake is licensed to practice in Utah (license number 5641317-4405) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1154003473.

Contact Information

	Stacey Mills Lake, NP
	999 E Murray Holladay Rd Ste 207, Holladay, UT 84117-5093
	(801) 268-2584
	Not Available

Map and Direction

Provider's Profile

Full Name	Stacey Mills Lake
Gender	Female
Speciality	Nurse Practitioner - Primary Care
Location	999 E Murray Holladay Rd Ste 207, Holladay, Utah
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1154003473
Provider Enumeration Date: 08/04/2023
Last Update Date: 01/22/2025

Medicare PECOS Information:

PECOS PAC ID: 0749643039
Enrollment ID: I20230905001693

Medical Identifiers

Medical identifiers for Stacey Mills Lake such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1154003473	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	5641317-4405 (Utah)	Secondary
363L00000X	Nurse Practitioner	5641317-4405 (Utah)	Secondary
363LP2300X	Nurse Practitioner - Primary Care	5641317-4405 (Utah)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Stacey Mills Lake allows following entities to bill medicare on her behalf.

Entity Name	Granger Medical Clinic Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1184657041 PECOS PAC ID: 3476465691 Enrollment ID: O20031105000159

Entity Name	Granger Medical Specialists Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1376159368 PECOS PAC ID: 4587074356 Enrollment ID: O20201105002207

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Stacey Mills Lake is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Stacey Mills Lake, NP 2965 W 3500 S, West Valley City, UT 84119-3602 Ph: (801) 965-3600	Stacey Mills Lake, NP 999 E Murray Holladay Rd Ste 207, Holladay, UT 84117-5093 Ph: (801) 268-2584

Reviews and Comments

Nurse Practitioner Nurses in Holladay, UT

Jun Lin, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 6405 S 3000 E, Holladay, UT 84121 Phone: 801-266-3113 Fax: 801-931-2166
Hillary Lowe Taggart, APRN Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 2290 E 4500 S Ste 210, Holladay, UT 84117 Phone: 801-516-8884
Brandie Blood Rudy, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 4252 S Highland Dr Ste 200, Holladay, UT 84124 Phone: 801-993-1800
Ms. Emily Kristen Van Os, PMHNP-BC, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2225 E Murray Holladay Rd Ste 108, Holladay, UT 84117 Phone: 801-609-6823 Fax: 801-951-7221
Gavin Woods, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1961 E Severn Cir, Holladay, UT 84124 Phone: 801-842-1917
Lillian Farris, DNP, APRN, PMHNP-BC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 4525 S 2300 E Ste 102, Holladay, UT 84117 Phone: 385-313-0401 Fax: 385-313-9762

Stacey Mills Lake, NP - Medicare Nurse Practitioner in Holladay, UT