Individual provider Active NPI

Tracy Lyons, DC

  • Chiropractor
  • Plymouth, WI
National Provider Identifier
1679650097
Registry record updated Apr 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3187 Issued in WI
Practice address
825 Walton Dr
Plymouth, WI 53073-5022
Phone
(920) 892-4322
NPI assigned
Nov 1, 2006
Last updated
Apr 1, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3187 WI Primary

Addresses

Primary practice location

825 Walton Dr
Plymouth, WI 53073-5022

Mailing address

825 Walton Dr
Plymouth, WI 53073-5022
Phone (920) 892-4322

Other identifiers 1

IdentifierTypeStateIssuer
38887000MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110323000237 WI Practitioner - Chiropractic 5698958023 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3100 Superior Ave
Sheboygan, WI 53081-1948
Phone (920) 459-8300

950 Woodlake Rd
Kohler, WI 53044-1348
Phone (920) 783-3150

PO Box
Suite 19070
Green Bay, WI 54307-9070

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Current Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Aug 27, 2012 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Aug 27, 2012 Accepting new patients
Columbia St Mary's Hospital Ozaukee, Inc. Past Accepting new patients

Locations

950 Woodlake Rd
Kohler, WI 53044
Phone (920) 783-3150

825 Walton Dr
Plymouth, WI 53073
Phone (920) 889-0302

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Organizations & group practices 4

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": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364774400000",
    "number": "1679650097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 WALTON DR",
            "city": "PLYMOUTH",
            "state": "WI",
            "postal_code": "530735022",
            "telephone_number": "920-892-4322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 WALTON DR",
            "city": "PLYMOUTH",
            "state": "WI",
            "postal_code": "530735022",
            "telephone_number": "920-892-4322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYONS",
        "first_name": "TRACY",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2013-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38887000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2013; 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.