Lacey Medical Group, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MB07677400 Issued in NJ

Legal business name

LACEY MEDICAL GROUP, LLC

Practice address

1044 Lacey Rd Ste 9
Forked River, NJ 08731-1051

Phone

(609) 693-0819

Fax

(609) 971-0834

NPI assigned

May 31, 2013

Organization subpart

No

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

Authorized official

Name

Ann Dipaolo, DONPI 1285604041

Title

Owner

Phone

(609) 693-0819

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ann M Dipaolo, D.O.

  • Family Medicine Physician
  • Forked River, NJ
  • NPI 1285604041
  Medicare reassignment Authorized official
• Sandra Lee Wiercinski, RN, APN

  • Adult Health Nurse Practitioner
  • Toms River, NJ
  • NPI 1427392711
  Medicare reassignment NPD
• Anar Askarovna Dossumbekova, M.D.

  • Allergy & Immunology Physician
  • Philadelphia, PA
  • NPI 1467716803
  NPD (past)

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1487091369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 LACEY RD STE 9",
            "city": "FORKED RIVER",
            "state": "NJ",
            "postal_code": "087311051",
            "telephone_number": "609-693-0819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 LACEY RD STE 9",
            "city": "FORKED RIVER",
            "state": "NJ",
            "postal_code": "087311051",
            "telephone_number": "609-693-0819",
            "fax_number": "609-971-0834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LACEY MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-31",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A",
        "authorized_official_last_name": "DIPAOLO",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-693-0819",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB07677400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0052680",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Kuna, DC
• Christine J. Kurnath, RNC, ANP
• Lacey Courier and Transportation Co, Inc
• Lacey Diagnostic Imaging, LLC.
• Lacey Family Medicine, L.L.C.
• Laceytownship First Aid Squad Inc
• Raquel Lambert, MSN, APN, PMHNP-BC
• Peter Lapis, M.D.
• Amanda Leadem, OT
• Linda J. Leonard, LCSW

• Family Medicine Physician in Forked River, NJ
• Providers in Forked River, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; 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.