Individual provider Active NPI

Stephen W Lacey, M.D.

  • Gastroenterology Physician
  • Southlake, TX
National Provider Identifier
1316923261
Registry record updated May 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
G7543 Issued in TX
Practice address
505 S Nolen Dr
Southlake, TX 76092-9167
Phone
(817) 424-1525
Fax
(817) 424-3491
NPI assigned
Dec 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X G7543 TX Primary

Addresses

Primary practice location

505 S Nolen Dr
Southlake, TX 76092-9167

Mailing address

PO Box 35629
Dallas, TX 75235-0629
Phone (214) 424-2213

Other identifiers 2

IdentifierTypeStateIssuer
82W275OtherTXBCBS
125114201MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20100507000091 TX Practitioner - GastroenterologyPractitioner - Internal Medicine 1850304015 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G7543TXMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Digestive Disease Consultants, PLLC Gastroenterology Current Accepting new patients
Texas Digestive Disease Consultants PLLC Gastroenterology CurrentSince Jun 15, 1988 Accepting new patients
Texas Digestive Disease Consultants, PLLC Gastroenterology CurrentSince Jun 15, 1988 Accepting new patients

Locations

601 S Main St
Keller, TX 76248
Phone (817) 741-4347

505 S Nolen Dr
Southlake, TX 76092
Phone (817) 424-1525

505 S Nolen Dr
#A
Southlake, TX 76092
Phone (817) 424-1525

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.

NPI Registry JSON

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369267200000",
    "number": "1316923261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35629",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752350629",
            "telephone_number": "214-424-2213",
            "fax_number": "214-231-2159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 S NOLEN DR",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760929167",
            "telephone_number": "817-424-1525",
            "fax_number": "817-424-3491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACEY",
        "first_name": "STEPHEN",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-21",
        "last_updated": "2013-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TX",
            "license": "G7543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "82W275",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125114201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

Verify at the official NPI Registry.