Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Blake Lyman, PA-C

Individual provider Physician Assistant · NPI 1497184188

Blake Lyman, PA-C is a Physician Assistant in Salt Lake City, Utah. Qualified in 2013, 13 years ago. Practices with Mountainstar Specialty Services LLC, a 29-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
13
Licensed in
UT
In the registry since
2013
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1160 E 3900 S Ste 5000
Salt Lake City, UT 84124-1275
Phone: (801) 261-7479
Fax: (801) 261-7429
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 9705935-1206 (UT)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1497184188
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedNovember 4, 2013
Last updated in NPPESNovember 13, 2023
Certification dateNovember 13, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Mountainstar Specialty Services Llc — 29 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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