Individual provider Active NPI

Lisa Ladle Archibald, PA-C

  • Physician Assistant
  • Murray, UT
National Provider Identifier
1770053167
Registry record updated Apr 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
8496933-1206 Issued in UT
Practice address
5171 S Cottonwood St
Murray, UT 84107-5704
Phone
(801) 507-4000
NPI assigned
Nov 28, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 8496933-1206 UT Primary

Addresses

Primary practice location

5171 S Cottonwood St
Murray, UT 84107-5704

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128

Other practice location 1

74 E Kimballs Ln Ste 300
Draper, UT 84020-5009
Phone (801) 572-0311

Other names 1

  • Lisa Ann Ladle Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRReguestService Other Bluemark LLC / Office Ally

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20190423001747 UT Practitioner - Physician Assistant 5092057018 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services Inc 3,948 clinicians

Practice addresses (Care Compare)

5121 S Cottonwood St
Murray, UT 84107-5701

5131 S Cottonwood St
Murray, UT 84107-5701
Phone (801) 507-3888

8 TH Ave and C St
LDS Hosp Eeg Phys GRP
Salt Lake City, UT 84143
Phone (801) 507-7000

Hospital & facility affiliations

  • Intermountain Medical Center Hospital, Murray, UT, CCN 460010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
8496933-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc CurrentSince Sep 29, 2024 Accepting new patients
Ihc Health Services, Inc. CurrentSince Jun 5, 2023 Accepting new patients
Ihc Health Services Inc CurrentSince Jun 5, 2023 Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

400 C St
Salt Lake Cty, UT 84143
Phone (435) 688-4080

5171 S Cottonwood St
South Salt Lake, UT 84107
Phone (801) 507-4000

1300 SE Cardinal Ct
Ste 190
Vancouver, WA 98683
Phone (360) 448-4479

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1543363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775606400000",
    "number": "1770053167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5171 S COTTONWOOD ST",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075704",
            "telephone_number": "801-507-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "74 E Kimballs Ln Ste 300",
            "address_purpose": "LOCATION",
            "city": "Draper",
            "state": "UT",
            "postal_code": "840205009",
            "country_code": "US",
            "telephone_number": "801-572-0311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ARCHIBALD",
        "first_name": "LISA",
        "middle_name": "LADLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-28",
        "last_updated": "2026-04-08",
        "certification_date": "2026-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "8496933-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRReguestService",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "LADLE",
            "middle_name": "ANN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Murray, UT

Sources for this page

Verify at the official NPI Registry.