Individual provider Active NPI

Katie Ann Lacy, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Dublin, OH
National Provider Identifier
1710469986
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRNCNP023491 Issued in OH
Practice address
6565 Perimeter Dr
Dublin, OH 43016-8461
Phone
(614) 328-9927
Fax
(614) 389-3727
NPI assigned
Sep 4, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F07181075 OH
Primary Care Nurse Practitioner 363LP2300X CNP.023491 OH
Family Nurse Practitioner 363LF0000X APRNCNP023491 OH Primary

Addresses

Primary practice location

6565 Perimeter Dr
Dublin, OH 43016-8461

Mailing address

5 Limited Pkwy E
Reynoldsburg, OH 43068-5300
Phone (614) 577-2279

Other identifiers 1

IdentifierTypeStateIssuer
APRNCNP023491OtherOHOHIO LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190304000159 OH Practitioner - Nurse Practitioner 6800135237 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Allergy and Asthma IncGroup PAC ID 0840512547, 12 clinicians

Practice addresses (Care Compare)

1015 W 5TH Ave
Columbus, OH 43212-2637
Phone (614) 328-9927

110 Polaris Pkwy
Suite 325
Westerville, OH 43082-8027
Phone (614) 328-9927

16900 Square Dr
Suite 104
Marysville, OH 43040-8948
Phone (614) 328-9927

5500 N Meadows Dr
Suite 110
Grove City, OH 43123-7688
Phone (614) 328-9927

6565 Perimeter Dr
Dublin, OH 43016-8461
Phone (614) 328-9927

7100 Graphics Way
Suite 2300
Lewis Center, OH 43035-1123
Phone (614) 328-9927

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRNCNP023491OHMDFamily Nurse Practitioner
F07181075OHMDFamily Nurse Practitioner
CNP.023491OHMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Allergy and Asthma Inc CurrentSince Oct 20, 2022 Accepting new patients
Premier Allergy CurrentSince Sep 25, 2022 Accepting new patients

Locations

6565 Perimeter Dr
Dublin, OH 43016
Phone (740) 304-0151

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1536019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1710469986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 LIMITED PKWY E",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "430685300",
            "telephone_number": "614-577-2279",
            "fax_number": "614-577-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6565 PERIMETER DR",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430168461",
            "telephone_number": "614-328-9927",
            "fax_number": "614-389-3727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACY",
        "first_name": "KATIE",
        "middle_name": "ANN",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-04",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "F07181075",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OH",
            "license": "CNP.023491",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRNCNP023491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO LICENSE",
            "identifier": "APRNCNP023491",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dublin, OH

Sources for this page

Verify at the official NPI Registry.