NPIMap

Individual provider Active NPI

Lacey A Cooper, NP-C

  • Adult Health Nurse Practitioner
  • Salt Lake City, UT
National Provider Identifier
1639796477
Registry record updated Nov 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
9043708-4409 Issued in UT
Practice address
50 N Medical Dr
Salt Lake City, UT 84132-0001
Phone
(702) 281-8904
NPI assigned
Jun 27, 2020
Last updated
Nov 12, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 9043708-4409 UT Primary

Addresses

Primary practice location

50 N Medical Dr
Salt Lake City, UT 84132-0001

Mailing address

797 Welles Cannon Rd
Grantsville, UT 84029-5563
Phone (702) 281-8904

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lcooper151791@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200825003685 UT Practitioner - Nurse Practitioner 5294152047 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MMG Stansbury Family Practice LLCGroup PAC ID 7911371422, 4 clinicians

Practice addresses (Care Compare)

3950 Tealby Way
Suite 101
Erda, UT 84074-8348
Phone (801) 827-0662

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tooele Clinic Corp CurrentSince Sep 1, 2020 Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Adult Services CurrentSince Sep 1, 2020 Accepting new patients
University of Utah Adult Services CurrentSince Sep 1, 2020 Accepting new patients
MMG Stansbury Family Practice LLC CurrentSince Sep 1, 2024 Accepting new patients

Locations

3950 Tealby Way
Ste 101
Erda, UT 84074
Phone (801) 827-0662

127 S 500 E
Ste 400B
Salt Lake City, UT 84102
Phone (801) 587-6478

746 E Winchester St
Ste 230B
Salt Lake City, UT 84107
Phone (801) 456-2333

1950 Circle of Hope Dr
Slc, UT 84112
Phone (801) 585-0100

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

2055 N Main St
Tooele, UT 84074
Phone (435) 843-3600

2321 N 400 E
Ste 300
Tooele, UT 84074
Phone (435) 833-9180

Interoperability endpoints

  • Direct secure messaging: lacey.cooper.1@28984.direct.athenahealth.com
  • Direct secure messaging: lcoope56@yourcarecommunity.org
  • Direct secure messaging: lcooper151791@direct.med.utah.edu

Organizations & group practices 5

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1593216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636675200000",
    "number": "1639796477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "797 WELLES CANNON RD",
            "city": "GRANTSVILLE",
            "state": "UT",
            "postal_code": "840295563",
            "telephone_number": "702-281-8904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 N MEDICAL DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "702-281-8904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "LACEY",
        "middle_name": "A",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-27",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "UT",
            "license": "9043708-4409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lcooper151791@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.