STACEY MILLS LAKE (NP) – Primary Care Nurse Practitioner, NPI 1154003473
Primary Care Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,657 NURSE PRACTITIONER in UT
Provider Addresses for STACEY MILLS LAKE (NP)
2965 W 3500 S
WEST VALLEY CITY, UT 841193602
Phone: (801) 965-3600
Type: Mailing
999 E MURRAY HOLLADAY RD STE 207
HOLLADAY, UT 841175093
Phone: (801) 268-2584
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 79 Open Payments records for all available years, with a total value of $1,779.
Total Amount is formed as General ($1,779) + Research ($0) + Ownership ($0) = $1,779.
Last reported payment date: 2024-12-31 • Largest payer in this snapshot: Lilly USA, LLC ($228).
Total Amount
$1,779
General + Research + Ownership
Payments
79
Total payment records
General Amount
$1,779
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-31
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Lilly USA, LLC | $228 |
| Amgen Inc. | $219 |
| ViiV Healthcare Company | $177 |
| Corcept Therapeutics | $127 |
| Janssen Biotech, Inc. | $104 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-09-05
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20230905001693 | I | Nurse Practitioner | UT | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 21 | 16 | $0 |
Insurance plans in this area (ZIP 84119)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | UT | |
| - | UT | |
| Critical Care (Intensivists), Pulmonary Disease | UT | |
| - | UT | |
| Sports Medicine, Family Practice | UT | |
| - | UT | |
| Family Practice | UT | |
| Internal Medicine | UT | |
| O B S T E T R I C S/ G Y N E C O L O G Y | UT | |
| Physician Assistant | UT |
Reviews
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