Individual provider Active NPI

Charleane Chantell Lacroix, CNM

  • Advanced Practice Midwife
  • Jamaica, NY
National Provider Identifier
1447568308
Registry record updated Jan 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
001401 Issued in NY
Practice address
1 Van Wyck PLZ
Jamaica, NY 11418-2826
Phone
(718) 206-6290
NPI assigned
Sep 14, 2010
Last updated
Jan 10, 2012By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 10, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X 001401 NY Primary

Addresses

Primary practice location

1 Van Wyck PLZ
Jamaica, NY 11418-2826

Mailing address

16355 Sayres Ave
Jamaica, NY 11433-3928
Phone (718) 344-0297

Other identifiers 1

IdentifierTypeStateIssuer
00695941MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170329000957 GA Practitioner - Certified Nurse Midwife (CNM) 8921276163 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
001401NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Mar 27, 2017 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Mar 27, 2017 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Stay Well Health Medical Care PC Past Accepting new patients
Healthy Women OB/GYN PC Past Accepting new patients
JHMC Diagnostic and Treatment Center Past Accepting new patients

Locations

1700 Hospital South Dr
Ste 500
Austell, GA 30106
Phone (770) 941-7717

5150 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152
Phone (678) 354-0230

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

4441 Atlanta Rd SE
Ste 206
Smyrna, GA 30080
Phone (770) 333-2020

Interoperability endpoints

  • Direct secure messaging: charleane.lacroix@chn.eclinicaldirectplus.com
  • Direct secure messaging: clacroix110746@directwellstar.org

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1284422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326153600000",
    "number": "1447568308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16355 SAYRES AVE",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114333928",
            "telephone_number": "718-344-0297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 VAN WYCK PLZ",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114182826",
            "telephone_number": "718-206-6290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACROIX",
        "first_name": "CHARLEANE",
        "middle_name": "CHANTELL",
        "name_prefix": "Ms.",
        "credential": "CNM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-14",
        "last_updated": "2012-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "NY",
            "license": "001401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00695941",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.