Active NPI
Blake Lawrence
- Nurse Practitioner
- Pleasant Grove, UT
National Provider Identifier
1902314289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 12078815-4405
- Practice address
- 2100 W Pleasant Grove Blvd Ste 270
Pleasant Grove, UT 84062-3375 - Phone
- (208) 316-9539
- NPI assigned
- Jan 20, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 12078815-4405 | UT | Primary |
Addresses
Primary practice location
2100 W Pleasant Grove Blvd Ste 270
Pleasant Grove, UT 84062-3375
Mailing address
634 S 1870 W
Orem, UT 84059-4963
Phone (208) 316-9539
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Livi Medical Services LLC | Current | Accepting new patients |
Locations
3030 N Central Ave
Ste 1200
Phoenix, AZ 85012
Phone (480) 607-0606
717 N Harwood St
Ste 550
Dallas, TX 75201
Phone (214) 628-9951
11693 S 700 E
Ste 100
Draper, UT 84020
Phone (801) 810-2147
11693 S 700 E
Draper, UT 84020
Phone (801) 810-2147
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706227200000",
"number": "1902314289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "634 S 1870 W",
"city": "OREM",
"state": "UT",
"postal_code": "840594963",
"telephone_number": "208-316-9539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 W PLEASANT GROVE BLVD STE 270",
"city": "PLEASANT GROVE",
"state": "UT",
"postal_code": "840623375",
"telephone_number": "208-316-9539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAWRENCE",
"first_name": "BLAKE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-01-20",
"last_updated": "2024-01-26",
"certification_date": "2023-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "UT",
"license": "12078815-4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasant Grove, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.