Shadrick Wyatt Tillotson, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

6223314-4405 Issued in UT

Practice address

2901 W Blue Grass Blvd Ste 200
Lehi, UT 84043-4190

Phone

(385) 510-5150

Fax

(866) 748-5235

NPI assigned

Aug 28, 2016

Last updated

Apr 2, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

89.69 of 100Reported as group

Quality

89.02

Promoting interoperability

85

Improvement activities

40

Cost

55.8

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.shadricktillotson@154909.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Premier Psychiatry Solutions

  • Psychiatric/Mental Health Nurse Practitioner
  • Lehi, UT
  • NPI 1538948005
  Medicare reassignment NPD Authorized official
• Deborah a Christensen PHD & Associates, Inc

  • Psychologist
  • Draper, UT
  • NPI 1891955936
  Medicare reassignment NPD
• Numinus Wellness Ut Inc

  • Psychiatry Physician
  • Springville, UT
  • NPI 1265092282
  Medicare reassignment
• Ascendant Behavioral Health LLC

  dba Ascendant Behavioral Health DBA LifeStance

  • Clinical Social Worker
  • Murray, UT
  • NPI 1689128605
  NPD
• First Choice Physical Therapy

  • Physical Therapist
  • Elko, NV
  • NPI 1801336169

  Family

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1528514809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 W BLUE GRASS BLVD STE 200",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840434190",
            "telephone_number": "385-510-5150",
            "fax_number": "866-748-5235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 W BLUE GRASS BLVD STE 200",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840434190",
            "telephone_number": "385-510-5150",
            "fax_number": "866-748-5235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLOTSON",
        "first_name": "SHADRICK",
        "middle_name": "WYATT",
        "name_prefix": "Mr.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-28",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "6223314-4405",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "UT",
            "license": "6223314-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cloe Thomson
• Crystal Ann Thorne, LCSW
• Korri Thornley
• Danielle Thurman, AMFT
• Andrea Doermann Tidwell, M.S.
• Madison Timm
• Sarah Timothy
• Timpanogos Regional Medical Services, Inc. (Westlake Emergency Center, a department of Timpanogos Regional Medical Center)
• Samantha Titus
• Eric Gene To, DMD

• Psychiatric/Mental Health Nurse Practitioner in Lehi, UT
• Providers in Lehi, UT by specialty
• Psychiatric/Mental Health Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.