NPIMap

Individual provider Active NPI

Kristina Diann Lacy, DPM

  • Foot & Ankle Surgery Podiatrist
  • Soldotna, AK
National Provider Identifier
1699119016
Registry record updated Jul 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
111585 Issued in AK
Practice address
240 Hospital PL
Suite 203
Soldotna, AK 99669-7559
Phone
(907) 714-5312
Fax
(907) 714-5200
NPI assigned
Apr 29, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 111585 AK Primary

Addresses

Primary practice location

240 Hospital PL
Suite 203
Soldotna, AK 99669-7559

Mailing address

2601 E Roosevelt St
Phoenix, AZ 85008-4973
Phone (602) 344-5011

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address klacy635765@ak.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160909000777 AK Practitioner - Podiatry 5496041998 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
California School of Podiatric Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Peninsula General Hospital IncGroup PAC ID 4587552575, 119 clinicians

Practice addresses (Care Compare)

240 Hospital PL
Soldotna, AK 99669-7559
Phone (907) 714-5312

Hospital & facility affiliations

  • Kenai Peninsula Home Health, LLC Home health agency, Soldotna, AK, CCN 027038
  • Central Peninsula General Hospital Hospital, Soldotna, AK, CCN 020024

Merit-based Incentive Payment System (MIPS)

Final score
75.44 of 100Reported as group
Quality
62.56
Promoting interoperability
81
Improvement activities
40
Cost
67.88

Merit-based Incentive Payment System (MIPS)

Final score
70.59 of 100Reported as group
Quality
83.37
Promoting interoperability
100
Improvement activities
40
Cost
16.65

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue316
Removal of nail tissue241
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
111585AKMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Central Peninsula General Hospital CurrentSince Sep 1, 2016 Accepting new patients
Central Peninsula General Hospital, Inc CurrentSince Sep 1, 2016 Accepting new patients
North Star Medical Imaging PLLC Current Accepting new patients
Central Peninsula General Hospital Inc. Current Accepting new patients
Central Peninsula General Hospital, Inc Past Accepting new patients

Locations

240 Hospital Pl
Ste 203
Soldotna, AK 99669
Phone (907) 714-5312

250 Hospital Pl
Soldotna, AK 99669
Phone (907) 714-4404

240 Hospital Pl
Soldotna, AK 99669
Phone (907) 262-7762

Interoperability endpoints

  • Direct secure messaging: klacy635758@ak.providencedirect.org

Organizations & group practices 7

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.

Hospital & facility affiliations 20

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1367193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594944000000",
    "number": "1699119016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 E ROOSEVELT ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850084973",
            "telephone_number": "602-344-5011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 HOSPITAL PL",
            "address_2": "SUITE 203",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697559",
            "telephone_number": "907-714-5312",
            "fax_number": "907-714-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACY",
        "first_name": "KRISTINA",
        "middle_name": "DIANN",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-29",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "AK",
            "license": "111585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "klacy635765@ak.providencedirect.org",
            "affiliation": "N",
            "endpointDescription": "Provider direct messaging address",
            "address_1": "240 Hospital Pl",
            "address_2": "Suite 203",
            "city": "Soldotna",
            "state": "AK",
            "country_code": "US",
            "postal_code": "996697559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Soldotna, AK

Sources for this page

Verify at the official NPI Registry.