LACEY BOEHMER, CPM, LDEM — NPI 1407640949 (Licensed & Credentialed Midwife in HOLLADAY, UT)

CMS-1500 Box 24J / 33a • NPI

1407640949

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

176B00000X

Licensed & Credentialed Midwife

Box 32 Service Location & ZIP+4

4359 S HIGHLAND DR, HOLLADAY, UT, 84124-3539

✓ 9-Digit EDI 837 ZIP+4 (84124-3539)

Practice Phone & Referral Fax

(888) 755-7155

Fax: (801) 723-3115

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1407640949 (LACEY BOEHMER, CPM, LDEM) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1407640949` (NPI-1 Individual Practitioner)
Provider / Legal Name	LACEY BOEHMER, CPM, LDEM
Plain-English Specialty	Licensed & Credentialed Midwife NUCC Code: `176B00000X` (Midwife)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	4359 S HIGHLAND DR, HOLLADAY, UT, 84124-3539
Practice Telephone / Fax	Tel: (888) 755-7155 \| Fax: (801) 723-3115
Administrative Mailing Address	941 W ZAFFRE HILLS LN, BLUFFDALE, UT, 84065-2004
Enumeration & Last Sync	Enumerated: 2025-04-08 \| CMS Record Updated: 2025-04-08

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

4359 S HIGHLAND DR, HOLLADAY, UT, 84124-3539

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Plain-English Taxonomy & CMS Crosswalk (176B00000X)

What Does Taxonomy Code 176B00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 176B00000X translates to:
"Licensed & Credentialed Midwife"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Midwife for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (LACEY BOEHMER, CPM, LDEM)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`176B00000X` — Midwife Plain English: Licensed & Credentialed Midwife	State: UT \| License: `11409200-3400` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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LACEY BOEHMER, CPM, LDEM (NPI #1407640949)