Active NPI
Benjamin Watkins Lacy V, MD
- Psychiatry Physician
- Gainesville, FL
National Provider Identifier
1861407611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD-12980
- Practice address
- 1601 SW Archer Rd
Gainesville, FL 32608-1135 - Phone
- (352) 376-1611
- NPI assigned
- Jul 30, 2006
- Last updated
- Dec 17, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD-12980 | HI | Primary |
Addresses
Primary practice location
1601 SW Archer Rd
Gainesville, FL 32608-1135
Mailing address
1601 SW Archer Rd
Gainesville, FL 32608-1135
Phone (352) 376-1611
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| VAD000 | Other | 1 |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD-12980 | HI | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450310400000",
"number": "1861407611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 SW ARCHER RD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326081135",
"telephone_number": "352-376-1611"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 SW ARCHER RD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326081135",
"telephone_number": "352-376-1611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACY",
"first_name": "BENJAMIN",
"middle_name": "WATKINS",
"name_prefix": "Dr.",
"name_suffix": "V",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-30",
"last_updated": "2015-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "HI",
"license": "MD-12980",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "1",
"identifier": "VAD000",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.