NPIMap

Individual provider Active NPI

Lacey Dively Moy, MD

  • Family Medicine Physician
  • Springfield, IL
National Provider Identifier
1013144021
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036129248 Issued in IL
Practice address
3220 Atlanta St
Springfield, IL 62707-8801
Phone
(217) 588-7400
Fax
(217) 588-7439
NPI assigned
Jun 17, 2009
Last updated
May 16, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036129248 IL Primary

Addresses

Primary practice location

3220 Atlanta St
Springfield, IL 62707-8801

Mailing address

3220 Atlanta St
Springfield, IL 62707-8801
Phone (217) 588-7400

Other identifiers 1

IdentifierTypeStateIssuer
036.129248OtherILMD LICENSE

Other names 1

  • Ms. Lacey M Dively Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120420000378 IL Practitioner - Family Practice 7618138413 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rush Medical College of Rush University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Physician ServicesGroup PAC ID 9032005681, 161 clinicians

Practice addresses (Care Compare)

3220 Atlanta St
Springfield, IL 62707-8801
Phone (217) 588-2600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.44 of 100Reported as group
Quality
71.79
Promoting interoperability
77
Improvement activities
40
Cost
75.71

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036129248ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Physician Services Family Medicine CurrentSince Jun 27, 2022 Accepting new patients
Springfield Clinic LLP Current Accepting new patients
Memorial Health Partners Family Medicine Current Accepting new patients
Memorial Physician Services Family Medicine Current Accepting new patients
Memorial Physician Services CurrentSince Jun 27, 2022 Accepting new patients
Family Medical Center of Chatham, LLC Family Medicine Current Accepting new patients
Memorial Physician Services Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

101 E Plummer Blvd
Chatham, IL 62629
Phone (217) 483-3487

3220 Atlanta St
Springfield, IL 62707
Phone (217) 588-2600

Interoperability endpoints

  • Direct secure messaging: laceymoy@memorial.allscriptsdirect.net
  • Direct secure messaging: laceymoy@sfc.allscriptsdirect.net

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1245196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684195200000",
    "number": "1013144021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 ATLANTA ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627078801",
            "telephone_number": "217-588-7400",
            "fax_number": "217-588-7439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 ATLANTA ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627078801",
            "telephone_number": "217-588-7400",
            "fax_number": "217-588-7439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOY",
        "first_name": "LACEY",
        "middle_name": "DIVELY",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-17",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036129248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD LICENSE",
            "identifier": "036.129248",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LACEY",
            "last_name": "DIVELY",
            "middle_name": "M",
            "prefix": "MS.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.