Active NPI
Lacey Grimes Lichtenstein, NP-C
- Family Nurse Practitioner
- Gulfport, MS
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- F1214550
- Practice address
- 1340 Broad Ave
Gulfport, MS 39501-2404 - Phone
- (228) 575-1234
- NPI assigned
- Jan 14, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | F1214550 | MS | Primary |
Addresses
Primary practice location
1340 Broad Ave
Gulfport, MS 39501-2404
Mailing address
1340 Broad Ave
Gulfport, MS 39501-2404
Phone (228) 572-1234
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1340 Broad Ave
Gulfport, MS 39501-2460
1340 Broad Ave
Gulfport, MS 39501-2465
15286 Community Rd
Gulfport, MS 39503-3509
Phone (228) 832-5151
4300 Leisure Time Dr
Diamondhead, MS 39525-3241
Phone (228) 255-4300
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F1214550 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orange Grove Urgent Care | Current | Accepting new patients | |
| Memorial Hospital at Gulfport | Current | Accepting new patients | |
| Memorial Hospital at Gulfport | Current | Accepting new patients | |
| Ocean Springs Urgent Care | Current | Accepting new patients | |
| Memorial Hospital at Gulfport | Past | Accepting new patients |
Locations
4300 Leisure Time Dr
Diamondhead, MS 39525
Phone (228) 255-4300
10556 Highway 49
Gulfport, MS 39503
Phone (228) 539-2399
4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872
1514 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 382-9222
Interoperability endpoints
- losbourn@direct.mhg.com
Organizations & group practices 6
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.
-
- Urology Physician
- Gulfport, MS
- NPI 1093142598
-
- Urgent Care Clinic/Center
- Ocean Springs, MS
- NPI 1871808022
-
- Urgent Care Clinic/Center
- Gulfport, MS
- NPI 1831330661
-
- General Acute Care Hospital
- Biloxi, MS
- NPI 1215546635
-
- Family Medicine Physician
- Diamondhead, MS
- NPI 1346677812
-
- General Acute Care Hospital
- Gulfport, MS
- NPI 1073606901
Hospital & facility affiliations 61
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Gulfport, MS
- NPI 1073606901
-
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Gulfport, MS
- NPI 1184956815
Hospital
-
- General Acute Care Hospital
- Biloxi, MS
- NPI 1215546635
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603756800000",
"number": "1720477714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1340 BROAD AVE",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395012404",
"telephone_number": "228-572-1234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1340 BROAD AVE",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395012404",
"telephone_number": "228-575-1234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICHTENSTEIN",
"first_name": "LACEY",
"middle_name": "GRIMES",
"name_prefix": "Mrs.",
"credential": "NP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-14",
"last_updated": "2020-10-27",
"certification_date": "2020-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MS",
"license": "F1214550",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.