Robert Stanley Lyman, PA-C
Individual provider Active NPI Physician Assistant · Blanding, UT
NPI 1154886950 · NPPES record last updated Jan 4, 2021
Key facts
- NPI
- 1154886950
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 11144168-8906 (UT)
- Practice address
- 802 S 200 W
Blanding, UT 84511-3910 - Phone
- (801) 931-7013
- NPI assigned
- Feb 5, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mountain Orthopaedics LLC
Practice addresses (Care Compare)
1551 Renaissance Town Dr
Suite 400
Bountiful, UT 84010-7676
1551 Renaissance Towne Dr
Suite 500
Bountiful, UT 84010-7678
Phone (801) 295-7200
201 W Layton Pkwy
Suite 400
Layton, UT 84041-3692
Phone (801) 295-7200
Hospital & facility affiliations
- Lakeview Hospital
- Intermountain Health Layton Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190528002308 | UT | Practitioner - Physician Assistant | 3375886732 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11144168-8906 | UT | MD | Physician Assistant |
Interoperability endpoints
- robert.lyman.1@27251.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 11144168-8906 | UT | Yes |
Addresses
Primary practice location
802 S 200 W
Blanding, UT 84511-3910
Mailing address
802 S 200 W
Blanding, UT 84511-3910
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0701369289 | Medicaid | UT |
Other providers in Blanding, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.