Individual provider Active NPI

Lacey Joanne Schwanebeck, NP

  • Nurse Practitioner
  • Wisconsin Rapids, WI
National Provider Identifier
1124793005
Registry record updated Jul 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11154-33 Issued in WI
Practice address
420 Dewey St Ste 1
Wisconsin Rapids, WI 54494-4714
Phone
(715) 421-4500
Fax
(715) 421-4509
NPI assigned
Aug 12, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 11154-33 WI Primary
Family Nurse Practitioner 363LF0000X 11154-33 WI

Addresses

Primary practice location

420 Dewey St Ste 1
Wisconsin Rapids, WI 54494-4714

Mailing address

801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008

Other practice location 1

5501A Vern Holmes Dr
Stevens Point, WI 54482-9791
Phone (715) 344-0172

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address Lacey.Schwanebeck@forefrontdermatology.emadirect.md
Direct Messaging Address Lacey.Schwanebeck@forefrontdermatology.emadirect.md

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210825000068 WI Practitioner - Nurse Practitioner 6608271960 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Wisconsin School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forefront Dermatology SCGroup PAC ID 3779471701, 650 clinicians

Practice addresses (Care Compare)

420 Dewey St
Suite 1
Wisconsin Rapids, WI 54494-4714
Phone (715) 421-4500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.45 of 100Reported as group
Promoting interoperability
97
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11154-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Forefront Dermatology, S.C. Current Accepting new patients
Forefront Dermatology, S.C. CurrentSince Aug 16, 2021 Accepting new patients
Forefront Dermatology, S.C. CurrentSince Aug 16, 2021 Accepting new patients
Forefront Dermatology, S.C. Past Accepting new patients

Locations

1400 Scheuring Rd
De Pere, WI 54115
Phone (920) 964-0229

801 York St
Manitowoc, WI 54220
Phone (866) 630-9882

5501A Vern Holmes Dr
Stevens Point, WI 54482
Phone (715) 344-0172

510 N 17th Ave
Ste C
Wausau, WI 54401
Phone (715) 849-5333

420 Dewey St
Ste 1
Wisconsin Rapids, WI 54494
Phone (715) 421-4500

Organizations & group practices 4

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.

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": "1628726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690416000000",
    "number": "1124793005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 DEWEY ST STE 1",
            "city": "WISCONSIN RAPIDS",
            "state": "WI",
            "postal_code": "544944714",
            "telephone_number": "715-421-4500",
            "fax_number": "715-421-4509"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5501A Vern Holmes Dr",
            "address_purpose": "LOCATION",
            "city": "Stevens Point",
            "state": "WI",
            "postal_code": "544829791",
            "country_code": "US",
            "telephone_number": "715-344-0172",
            "fax_number": "715-344-3684",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCHWANEBECK",
        "first_name": "LACEY",
        "middle_name": "JOANNE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-12",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "11154-33",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "11154-33",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Lacey.Schwanebeck@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "420 Dewey St Ste 1",
            "city": "Wisconsin Rapids",
            "state": "WI",
            "country_code": "US",
            "postal_code": "544944714",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Lacey.Schwanebeck@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "5501A Vern Holmes Dr",
            "city": "Stevens Point",
            "state": "WI",
            "country_code": "US",
            "postal_code": "544829791",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wisconsin Rapids, WI

Sources for this page

Verify at the official NPI Registry.