Lacey Beth Walls, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2018-01570 Issued in NC

Practice address

335 Penny LN
Concord, NC 28025-1221

Phone

(704) 784-5901

Fax

(704) 721-0413

NPI assigned

May 17, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Lacey Beth Elwyn Former name

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology Group of the CarolinasGroup PAC ID 3678514759, 24 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

85.93 of 100Reported as group

Quality

69.47

Promoting interoperability

100

Improvement activities

40

Cost

83.64

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: l.elwyn@directaddress.net

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.

• Dermatology Group of the Carolinas

  • Dermatology Physician
  • Concord, NC
  • NPI 1437110772
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1368748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1790121689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 PENNY LN",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251221",
            "telephone_number": "704-784-5901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 PENNY LN",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251221",
            "telephone_number": "704-784-5901",
            "fax_number": "704-721-0413"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13660 S Jog Rd Ste 8",
            "address_purpose": "LOCATION",
            "city": "Delray Beach",
            "state": "FL",
            "postal_code": "334463806",
            "country_code": "US",
            "telephone_number": "618-615-2500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7421 N University Dr Ste 307",
            "address_purpose": "LOCATION",
            "city": "Tamarac",
            "state": "FL",
            "postal_code": "333216102",
            "country_code": "US",
            "telephone_number": "618-615-2500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLS",
        "first_name": "LACEY",
        "middle_name": "BETH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-17",
        "last_updated": "2022-07-21",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "276541",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "OS14737",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NC",
            "license": "2018-01570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LACEY",
            "last_name": "ELWYN",
            "middle_name": "BETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Leigh Wallace, PHARM D
• Tamera Waller-Drye
• Carly Lynne Waller, CNM
• Laura Elizabeth Waller
• Melissa Waller
• Bonnie Leanne Walsh, MSE, RD, LDN
• Charlene M Walsh, PA-C
• Vanessa M Walter, LCSWA
• Kelsey Nicole Walters, LCMHCA
• Shanna M Walters, DNP-FNP-BC

• Dermatology Physician in Concord, NC
• Providers in Concord, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.

Verify at the official NPI Registry.