Kate Lillie, PA-C
Individual provider Active NPI Physician Assistant · Salt Lake City, UT
NPI 1801410451 · NPPES record last updated Sep 1, 2022
Key facts
- NPI
- 1801410451
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 12993974-1206 (UT)
- Practice address
- 660 S 200 E Ste 250
Salt Lake City, UT 84111-3846 - Phone
- (801) 359-2256
- NPI assigned
- May 29, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Confederated Tribes of the Goshute Reservation
Practice addresses (Care Compare)
660 S 200
Suite 250
Salt Lake City, UT 84111-3846
660 S 200 E
Salt Lake, UT 84111-3846
Phone (801) 395-2256
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221010001380 | TX | Practitioner - Physician Assistant | 2365828662 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12993974-1206 | UT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Confederated Tribes of the Goshute Reservation | Current |
Accepting new patients |
Locations
660 S 200 E
Slc, UT 84111
Phone (801) 355-1528
660 S 200 E
Ste 250
Slc, UT 84111
Phone (801) 395-2256
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 12993974-1206 | UT | Yes |
Addresses
Primary practice location
660 S 200 E Ste 250
Salt Lake City, UT 84111-3846
Mailing address
3015 NE Overlook Dr Apt 735
Hillsboro, OR 97124-7204
Phone (907) 406-8310
Other providers in Salt Lake City, UT
- Rilla Annette Liles
- Elisabeth Thomas Lilja
- Kristen Hansord Lilja
- Brian B Liljenquist
- Rebecca Liljenquist
- Lane Camille Lillywhite
- Sydney Lilomaiava
- Shane Lilya
- Alexander Keng Lim
- Hwee Yong Lim
All providers in Salt Lake City, UT · Physician Assistant in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.