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Active NPI 1154003473 Individual Practitioner Female Practitioner

Stacey Mills Lake , NP

Nurse Practitioner - Primary Care • Holladay, UT

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Stacey Lake, NP is a certified Nurse Practitioner - Primary Care practicing in Holladay, UT. With approximately 3 years of clinical experience since completing medical education in 2023, Stacey Lake delivers high-quality medical care to the local community at 999 E MURRAY HOLLADAY RD STE 207.

Stacey Lake is affiliated with Granger Medical Clinic Pc and accepts Medicare assignment.

Frequently performed procedures and clinical services include visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's, established patient outpatient office visit, annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

999 E Murray Holladay Rd Ste 207

Holladay, UT 841175093

Telephone 8012682584
Associated Practice Facility / Clinic
🏢 Holladay Family Practice Facility NPI 1437255866

Medicare Profile & Education

Medical School

Other

Graduation Year

2023

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Nurse Practitioner - Primary Care in Holladay, UT

Rising Specialist (<5 Yrs)
Practitioner Clinical Experience
3 Yrs Matches City Avg
City Avg: 3.0 Yrs
State Avg: 6.3 Yrs
Regional Practice Density
1 Specialists

Practicing in Holladay, UT (95 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
42.1% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Lake (3 Years) 3 Yrs
Holladay Specialty Average (3.0 Years) 3.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's
74 42 $39.80 $12.97
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
74 39 $239.00 $100.49
99213 Established patient office or other outpatient visit, typically 15 minutes
51 39 $154.00 $73.33
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
35 35 $229.00 $104.61
G0444 Annual depression screening, 5 to 15 minutes
29 29 $35.00 $15.06
G0008 Administration of influenza virus vaccine
13 13 $44.00 $30.87
90662 Influenza vaccine split virus, preservative free
13 13 $71.92 $69.62
G0009 Administration of pneumococcal vaccine
11 11 $44.00 $30.87
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use
11 11 $402.00 $291.24

Medical Specialties & State Licenses

CMS Verified: 2025-01-22
Nurse Practitioner - Primary Care Primary Specialty

NUCC Taxonomy Code: 363LP2300X

State License UT 5641317-4405

Definition to come...

Nurse Practitioner - Family

NUCC Taxonomy Code: 363LF0000X

State License UT 5641317-4405

Definition to come...

Nurse Practitioner

NUCC Taxonomy Code: 363L00000X

State License UT 5641317-4405

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Hospital & Practice Group Affiliations

Granger Medical Clinic Pc

12391 S 4000, Riverton, UT 840967012

Phone: 8013021700

Granger Medical Clinic Pc

999 E Murray Holladay Rd, Salt Lake City, UT 841174901

Phone: 8012682584

Granger Medical Clinic Pc

2965 W 3500, West Valley City, UT 841193602

Phone: 8019653600

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

8 Associated Practitioners
NPI 1285609313

Doctor of Medicine (M.D.)

Dr. Gene Fuller , MD

Family Medicine

NPI 1396710281

Doctor of Medicine (M.D.)

NPI 1588043871

Doctor of Medicine (M.D.)

NPI 1659350049

Doctor of Medicine (M.D.)

Dr. David Larsen , MD

Family Medicine

NPI 1679548564

Doctor of Medicine (M.D.)

Carol Warnick , NP

Nurse Practitioner - Family

NPI 1710952791

Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Business Mailing Address January 22, 2025

Registered at 2965 W 3500 S, WEST VALLEY CITY, UT 841193602 (Tel: 8019653600)

📍
Updated Business Mailing Address August 21, 2023

Registered at 7181 S CAMPUS VIEW DR STE 200, WEST JORDAN, UT 840844312 (Tel: 8019653600)

NPI Profile Active August 04, 2023

NPI status registered as active in NPPES database

📍
Updated Practice Location August 04, 2023

Registered at 999 E MURRAY HOLLADAY RD STE 207, HOLLADAY, UT 841175093 (Tel: 8012682584)

📍
Updated Business Mailing Address August 04, 2023

Registered at 2707 E PARTRIDGE CV, SANDY, UT 840932832 (Tel: 8015027347)

👤
Provider Name / Credentials Updated August 04, 2023

Recorded as STACEY LAKE, NP

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 04, 2023

Nurse Practitioner (License #5641317-4405 in UT)

🟢
Initial NPI Registration & Enumeration August 04, 2023

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1154003473
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 04, 2023
Last Update: January 22, 2025
Sole Proprietor: No

Mailing Address

2965 W 3500 S

West Valley City, UT 841193602

Phone: 8019653600

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.