NPIMap

Individual provider Active NPI

Carly Agnes Lacroix, DO

  • Internal Medicine Physician
  • Pueblo, CO
National Provider Identifier
1316328560
Registry record updated Jul 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DR.0059223 Issued in CO
Practice address
300 Colorado Ave
Pueblo, CO 81004-2006
Phone
(719) 543-8711
Fax
(719) 543-0171
NPI assigned
Jun 13, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X DR.0059223 CO Primary

Addresses

Primary practice location

300 Colorado Ave
Pueblo, CO 81004-2006

Mailing address

110 E Routt Ave
Pueblo, CO 81004-2117
Phone (719) 543-8711

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL CORHIO Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20180207000891 CO Practitioner - Osteopathic Manipulative MedicinePractitioner - Internal Medicine 4688981319 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Osteopathic Manipulative MedicineAlso: Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

300 Colorado Ave
Pueblo, CO 81004-2006
Phone (719) 543-8711

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pueblo Community Health Center Inc CurrentSince Dec 31, 2017 Accepting new patients
Pueblo Community Health Center Inc Multi-Specialty CurrentSince Dec 31, 2017 Accepting new patients
Pueblo Community Health Center Inc. Past Accepting new patients

Locations

400 W 16th St
Pueblo, CO 81003
Phone (719) 584-4000

110 E Routt Ave
Pueblo, CO 81004
Phone (719) 543-8718

900 W Orman Ave
Rm MT118
Pueblo, CO 81004
Phone 7195438711385

300 Colorado Ave
Pueblo, CO 81004
Phone (719) 543-8718

Interoperability endpoints

  • Direct secure messaging: carly.lacroix.p1@direct.pueblochc.nextgenshare.com

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 11

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": "1434153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657152000000",
    "number": "1316328560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E ROUTT AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042117",
            "telephone_number": "719-543-8711",
            "fax_number": "719-543-0171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 COLORADO AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042006",
            "telephone_number": "719-543-8711",
            "fax_number": "719-543-0171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACROIX",
        "first_name": "CARLY",
        "middle_name": "AGNES",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-13",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0059223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "CORHIO",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "300 Colorado Ave",
            "city": "Pueblo",
            "state": "CO",
            "country_code": "US",
            "postal_code": "810042006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.