Individual provider Active NPI

Ammon Lott, NP

  • Nurse Practitioner
  • Provo, UT
National Provider Identifier
1902489032
Registry record updated Sep 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
9801445-4405 Issued in UT
Practice address
395 W Bulldog Blvd
Provo, UT 84604-3311
Phone
(801) 357-7081
NPI assigned
May 5, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 9801445-4405 UT Primary

Addresses

Primary practice location

395 W Bulldog Blvd
Provo, UT 84604-3311

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128

Other practice location 1

972 N 600 E
Spanish Fork, UT 84660-1306
Phone (801) 465-4896

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service 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
I20210827001544 UT Practitioner - Nurse Practitioner 3173928256 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Revere Health PCGroup PAC ID 7517868508, 407 clinicians

Practice addresses (Care Compare)

1055 N 500
Provo, UT 84604-3305

512 E Lakeview Pkwy
Provo, UT 84606-7311
Phone (801) 812-5591

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9801445-4405UTMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Revere Health PC CurrentSince Mar 6, 2023 Accepting new patients
Ihc Health Services Inc CurrentSince Jan 5, 2026 Accepting new patients
Ihc Health Services, Inc. CurrentSince Jan 5, 2026 Accepting new patients
Revere Health PC CurrentSince Mar 6, 2023 Accepting new patients
Spinal Interventions, PLLC CurrentSince Aug 1, 2021 Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

98 N 1100 E
Ste 302
American Fork, UT 84003
Phone (801) 357-7081

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

230 N 1200 E
Ste 201
Lehi, UT 84043
Phone (801) 852-9555

1055 N 500 W
Ste 212
Provo, UT 84604
Phone (801) 374-2362

1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000

395 W Cougar Blvd
Provo, UT 84604
Phone (801) 357-4141

280 River Park Dr
Ste 200
Provo, UT 84604
Phone (801) 223-4860

395 W Cougar Blvd
Ste 503
Provo, UT 84604
Phone (801) 357-4600

280 River Park Dr
Ste 350
Provo, UT 84604
Phone (801) 223-4860

972 N 600 E
Spanish Fork, UT 84660
Phone (385) 265-6060

819 E Market Place Dr
Ste 2C
Spanish Fork, UT 84660

819 E Market Place Dr
Spanish Fork, UT 84660
Phone (385) 344-6600

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

Interoperability endpoints

  • Direct secure messaging: ammonlott@cuccu.allscriptsdirect.net

Organizations & group practices 7

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": "1620172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788393600000",
    "number": "1902489032",
    "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": "395 W BULLDOG BLVD",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043311",
            "telephone_number": "801-357-7081"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "972 N 600 E",
            "address_purpose": "LOCATION",
            "city": "Spanish Fork",
            "state": "UT",
            "postal_code": "846601306",
            "country_code": "US",
            "telephone_number": "801-465-4896",
            "fax_number": "801-465-3267",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOTT",
        "first_name": "AMMON",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-05",
        "last_updated": "2026-09-03",
        "certification_date": "2026-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "9801445-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "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": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.