Individual provider Active NPI

Wilmer Avancy Lacson

  • Occupational Therapist
  • Yonkers, NY
National Provider Identifier
1477881365
Registry record updated Jun 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
0157731 Issued in NY
Practice address
66 Crisfield St
Unit 1-Q
Yonkers, NY 10710-1243
Phone
(917) 484-1465
NPI assigned
Dec 3, 2009
Last updated
Jun 4, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 4, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 0157731 NY Primary

Addresses

Primary practice location

66 Crisfield St
Unit 1-Q
Yonkers, NY 10710-1243

Mailing address

315 E 108TH St
2C
New York, NY 10029-4245
Phone (917) 484-1465

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170223000877 NY Practitioner - Occupational Therapist in Private Practice 9234413915 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

212 Cromwell Ave
Staten Island, NY 10305-1308
Phone (929) 484-1465

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0157731NYMDOccupational Therapist
015773NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wilmer Lacson Rehab Services,Inc. Past Accepting new patients

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, 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": "1259798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464998400000",
    "number": "1477881365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 E 108TH ST",
            "address_2": "2C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100294245",
            "telephone_number": "917-484-1465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 CRISFIELD ST",
            "address_2": "UNIT 1-Q",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107101243",
            "telephone_number": "917-484-1465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACSON",
        "first_name": "WILMER",
        "middle_name": "AVANCY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-12-03",
        "last_updated": "2016-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "0157731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yonkers, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.