Benjamin Grant Lauritzen, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

125055456 Issued in IL

Practice address

15 S 1000 E Ste 200
Payson, UT 84651-5592

Phone

(801) 465-2800

Fax

(801) 465-4770

NPI assigned

Aug 6, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Utah Valley Pediatrics L.L.C.

  • Pediatrics Physician
  • Provo, UT
  • NPI 1497812721
  NPD (past)

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

{
    "created_epoch": "1217980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658102400000",
    "number": "1659537850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 S 1000 E STE 200",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846515592",
            "telephone_number": "801-465-2800",
            "fax_number": "801-465-4770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 S 1000 E STE 200",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846515592",
            "telephone_number": "801-465-2800",
            "fax_number": "801-465-4770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAURITZEN",
        "first_name": "BENJAMIN",
        "middle_name": "GRANT",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-06",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "80037461205",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "125055456",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870549057",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karolee Koller, LCSW
• Thomas Kramer, PH.D.
• Krogue Chiropractic LLC
• Jonathan Krogue, DC
• Joan R. Landes, CMHC
• Kevin Lee, MD
• Jason Lefrandt, PHD
• Jason Riki Lewis
• John A Linford, SLP
• Ryan Scott Lofthouse, DO

• Pediatrics Physician in Payson, UT
• Providers in Payson, UT by specialty
• Pediatrics Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.