Individual provider Active NPI

Carolyn Smith Lacey, M.D.

  • Cardiovascular Disease Physician
  • Walnut Creek, CA
National Provider Identifier
1295717411
Registry record updated Aug 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
C131968 Issued in CA
Practice address
1450 Treat Blvd
Suite 220B
Walnut Creek, CA 94597-2168
Phone
(925) 937-1770
Fax
(925) 937-0630
NPI assigned
Nov 15, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101238189 VA
Cardiovascular Disease Physician 207RC0000X C131968 CA Primary

Addresses

Primary practice location

1450 Treat Blvd
Suite 220B
Walnut Creek, CA 94597-2168

Mailing address

Dept 34929
P.O. Box 39000
San Francisco, CA 94139-0001
Phone (925) 952-2828

Other identifiers 1

IdentifierTypeStateIssuer
P01474765OtherCARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20150109001941 CA Practitioner - Cardiovascular Disease (Cardiology) 3678797768 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
John Muir Physician NetworkGroup PAC ID 6608789813, 488 clinicians

Practice addresses (Care Compare)

1450 Treat Blvd
Suite 220B
Walnut Creek, CA 94597-2168
Phone (925) 937-1770

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.32 of 100Reported as group
Quality
89.54
Promoting interoperability
100
Improvement activities
40
Cost
74.34

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair30

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101238189VAMDInternal Medicine Physician
C131968CAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
John Muir Physician Network CurrentSince Oct 19, 2014 Accepting new patients
John Muir Health Past Accepting new patients
John Muir Health Past Accepting new patients

Locations

3100 San Pablo Ave
Ste 430
Berkeley, CA 94702
Phone (415) 476-3360

2400 Balfour Rd
Ste 201
Brentwood, CA 94513
Phone (925) 308-8112

2400 Balfour Rd
Ste 120
Brentwood, CA 94513
Phone (925) 308-8112

2485 High School Ave
Ste 100
Concord, CA 94520
Phone (925) 671-0610

2700 Grant St
Ste 106
Concord, CA 94520
Phone (925) 685-7598

2700 Grant St
Ste 309
Concord, CA 94520
Phone (925) 674-2650

3480 Buskirk Ave
Ste 110A
Pleasant Hill, CA 94523
Phone (925) 674-2610

380 Civic Dr
Ste 100
Pleasant Hill, CA 94523
Phone (925) 284-3840

5860 Owens Dr
Ste 230
Pleasanton, CA 94588
Phone (925) 734-0336

1450 Treat Blvd
Ste 220B
Walnut Creek, CA 94597
Phone (925) 937-1770

Interoperability endpoints

  • Direct secure messaging: clacey35260@ehr.johnmuirhealth.com

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
John Muir Medical Center - Concord CampusConcord, CA, CCN 050496 Hospital Corporate Officer Jan 1, 2023
John Muir Behavioral Health CenterConcord, CA, CCN 054131 Hospital Corporate Officer Jan 1, 2023
John Muir Walnut Creek I/P Rehab UnitWalnut Creek, CA, CCN 05T180 Hospital Corporate Director Jan 1, 2022
John Muir Home Health ServicesConcord, CA, CCN 057276 Home health agency Corporate Officer Jan 1, 2022

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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 3

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": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439251200000",
    "number": "1295717411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT 34929",
            "address_2": "P.O. BOX 39000",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941390001",
            "telephone_number": "925-952-2828",
            "fax_number": "925-952-2850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 TREAT BLVD",
            "address_2": "SUITE 220B",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945972168",
            "telephone_number": "925-937-1770",
            "fax_number": "925-937-0630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACEY",
        "first_name": "CAROLYN",
        "middle_name": "SMITH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-15",
        "last_updated": "2015-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101238189",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "C131968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01474765",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.