Active NPI
Body Renaissance LLC
- Family Nurse Practitioner
- Payson, UT
National Provider Identifier
1417828971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- Legal business name
- BODY RENAISSANCE LLC
- Practice address
- 86 S Main St
Payson, UT 84651-2223 - Phone
- (385) 501-1999
- Fax
- (801) 206-3338
- NPI assigned
- Sep 16, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Karl F Stemmler, MPA
- Title
- Credentialing Director
- Phone
- (619) 258-6200
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | Primary |
Addresses
Primary practice location
86 S Main St
Payson, UT 84651-2223
Mailing address
742 N 350 E
Genola, UT 84655-8326
Phone (385) 510-5282
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20251118002639 | UT | Part B Supplier - Clinic/Group Practice | 7810488723 |
Receives reassigned benefits from 1 practitioner Practice locations: Payson, UT; Genola, UT |
National Provider Directory
National Provider DirectoryLocations
86 S Main St
Payson, UT 84651
Phone (385) 501-1999
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1757980800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1760313600000",
"number": "1417828971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "742 N 350 E",
"city": "GENOLA",
"state": "UT",
"postal_code": "846558326",
"telephone_number": "385-510-5282",
"fax_number": "801-206-3338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "86 S MAIN ST",
"city": "PAYSON",
"state": "UT",
"postal_code": "846512223",
"telephone_number": "385-501-1999",
"fax_number": "801-206-3338"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BODY RENAISSANCE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2025-09-16",
"last_updated": "2025-10-13",
"certification_date": "2025-10-13",
"status": "A",
"authorized_official_last_name": "STEMMLER",
"authorized_official_first_name": "KARL",
"authorized_official_middle_name": "F",
"authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
"authorized_official_telephone_number": "619-258-6200",
"authorized_official_credential": "MPA"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Payson, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.