NPIMap

Individual provider Active NPI

Spencer Clark Lacy, MD

  • Hospitalist Physician
  • Wilmington, NC
National Provider Identifier
1710564174
Registry record updated Jul 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
2024-01297 Issued in NC
Practice address
2131 S 17TH St
Wilmington, NC 28401-7407
Phone
(910) 667-2606
Fax
(910) 815-5698
NPI assigned
Mar 24, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125.077430 IL
Internal Medicine Physician 207R00000X 2024-01297 NC
Hospitalist Physician 208M00000X 2024-01297 NC Primary

Addresses

Primary practice location

2131 S 17TH St
Wilmington, NC 28401-7407

Mailing address

PO Box 936857
Atlanta, GA 31193-6857
Phone (910) 667-2606

Other practice location 1

2160 S 1st Ave
Maywood, IL 60153-3328
Phone (888) 584-7888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20240813000537 NC Practitioner - HospitalistPractitioner - Internal Medicine 6002204088 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
University of Miami, LM Miller School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 384-5416

2131 S 17TH St
Wilmington, NC 28401-7407
Phone (910) 667-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125.077430ILMDInternal Medicine Physician
2024-01297NCMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Loyola University Medical Center Current Accepting new patients
Novant Health Medical Group Coastal Region, LLC Current Accepting new patients
NMG Health Services LLC CurrentSince Jun 15, 2024 Accepting new patients
Novant Health Medical Group Coastal Region, LLC Internal Medicine CurrentSince Jun 15, 2024 Accepting new patients

Locations

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

800 Jefferson St
Ste 112
Whiteville, NC 28472
Phone (910) 642-8164

2131 S 17th St
Wilmington, NC 28401
Phone (910) 342-3000

Interoperability endpoints

  • Direct secure messaging: slacy139869@direct.luhs.org

Organizations & group practices 5

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 9

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

NPI Registry JSON

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

{
    "created_epoch": "1616544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1710564174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936857",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936857",
            "telephone_number": "910-667-2606",
            "fax_number": "910-815-5698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 S 17TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017407",
            "telephone_number": "910-667-2606",
            "fax_number": "910-815-5698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2160 S 1st Ave",
            "address_purpose": "LOCATION",
            "city": "Maywood",
            "state": "IL",
            "postal_code": "601533328",
            "country_code": "US",
            "telephone_number": "888-584-7888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LACY",
        "first_name": "SPENCER",
        "middle_name": "CLARK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-24",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.077430",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2024-01297",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NC",
            "license": "2024-01297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.