Shanon Renee Lacy, D.O.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

56999-21 Issued in WI

Practice address

8901 W Lincoln Ave
West Allis, WI 53227-2409

Phone

(414) 328-7675

NPI assigned

Jun 12, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pathology

Education

Chicago College of Medicine and Surgery, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Great Lakes Pathologists SCGroup PAC ID 7315850682, 55 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008
• Aurora St Lukes Medical Center Hospital, Milwaukee, WI, CCN 520138
• Aurora Medical Center - Summit Hospital, Summit, WI, CCN 520206
• Aurora Medical Center Kenosha Hospital, Kenosha, WI, CCN 520189
• Aurora Memorial Hospital Burlington Hospital, Burlington, WI, CCN 520059

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: slacy53634@direct.myadvocateaurora.org

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.

• Great Lakes Pathologists SC

  • Anatomic Pathology & Clinical Pathology Physician
  • West Allis, WI
  • NPI 1689695934
  Medicare reassignment Care Compare group NPD
• A2Cl Services, LLC

  • Clinical Medical Laboratory
  • West Allis, WI
  • NPI 1710064811
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Aurora Health Care Metro, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Cudahy, WI
  • NPI 1235355983

  Hospital

  Care Compare affiliation
• Aurora Health Care Metro, Inc.

  • General Acute Care Hospital
  • Milwaukee, WI
  • NPI 1861447179
  Care Compare affiliation
• Aurora Health Care Southern Lakes, Inc.

  • General Acute Care Hospital
  • Kenosha, WI
  • NPI 1225156888
  Care Compare affiliation
• Aurora Health Care Southern Lakes, Inc.

  • General Acute Care Hospital
  • Summit, WI
  • NPI 1699008029
  Care Compare affiliation
• Aurora Health Care Southern Lakes, Inc.

  • General Acute Care Hospital
  • Burlington, WI
  • NPI 1861557753
  Care Compare affiliation
• Prohealth Waukesha Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Waukesha, WI
  • NPI 1629056890
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1003076142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 N WATER ST UNIT 206",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532026056",
            "telephone_number": "317-285-9918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8901 W LINCOLN AVE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532272409",
            "telephone_number": "414-328-7675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACY",
        "first_name": "SHANON",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-12",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "WI",
            "license": "56999-21",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WI",
            "license": "56999-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "8901 W Lincoln Ave",
            "city": "West Allis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532272409",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "slacy53634@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "8901 W Lincoln Ave",
            "city": "West Allis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532272409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amanda A La Bode, SAC-IT
• La Causa, Inc.
• David William La Rock Jr., PHARMACIST
• Madeline Elizabeth Labecki
• Laurie A Lacoursiere, RD
• John Laczkowski, OD
• Tammy Laduron, LPN
• Valerie June Lake, RN
• Lakeshore Medical Clinic, LTD
• Lakeshore Medical Clinic, LTD.

• Anatomic Pathology & Clinical Pathology Physician in West Allis, WI
• Providers in West Allis, WI by specialty
• Anatomic Pathology & Clinical Pathology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.