Martin S Lacey, MD

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

44353 Issued in MN

Practice address

640 Jackson St
MC 11503B
Saint Paul, MN 55101-2502

Phone

(651) 254-3792

Fax

(651) 254-8208

NPI assigned

Feb 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Gillette Children'S Specialty Healthcare

  • Multi-Specialty Clinic/Center
  • St. Paul, MN
  • NPI 1225119175
  Medicare reassignment NPD
• Gillette Children'S Specialty Healthcare

  • Multi-Specialty Clinic/Center
  • Saint Cloud, MN
  • NPI 1982090528
  NPD

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350950400000",
    "number": "1821064288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8100 34TH AVE S",
            "address_2": "MAIL STOP 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251672",
            "telephone_number": "952-883-5463",
            "fax_number": "952-883-5395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 JACKSON ST",
            "address_2": "MC 11503B",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012502",
            "telephone_number": "651-254-3792",
            "fax_number": "651-254-8208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACEY",
        "first_name": "MARTIN",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-27",
        "last_updated": "2012-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "MN",
            "license": "44353",
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "WI",
            "license": "45762",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "322800200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott Allen Labott Jr.
• Karen S Labounty, PHD, LP
• Beverly Labrie, LMFT
• Hannah Lacasse
• Alexandra Michelle Lacey, M.D.
• William Joseph Lackey
• Joshua Ernest Lackner, MD
• Shannon G Lackner
• Stella Rae Lacroix-Dalluhn
• Kelsey Lacroix, PA-C

• Plastic and Reconstructive Surgery Physician in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Plastic and Reconstructive Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.