NPIMap

Individual provider Active NPI

Lacey Sullivan, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Pascagoula, MS
National Provider Identifier
1962707745
Registry record updated Jun 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
MD.35922 Issued in AL
Practice address
2809 Denny Ave
Pascagoula, MS 39581
Phone
(228) 818-6063
Fax
(228) 809-2254
NPI assigned
Jan 25, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X MD.35922 AL Primary

Addresses

Primary practice location

2809 Denny Ave
Pascagoula, MS 39581

Mailing address

5052 W 4TH St Ste 7
Hattiesburg, MS 39402-1069
Phone (601) 261-2587

Other practice location 1

3109 Bienville Blvd
Ocean Springs, MS 39564-4361
Phone (228) 818-4056

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, MS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170703000833 AL Practitioner - Pathology 3274802491 Reassigns benefits to 1 organization
I20190507002605 MS Practitioner - Pathology 3274802491 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Tulane University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Urology Associates of Mobile, P.a.Group PAC ID 3870497951, 60 clinicians
Singing River Pathology PLLCGroup PAC ID 3476859703, 5 clinicians

Practice addresses (Care Compare)

1153 Ocean Springs Rd
Ocean Springs, MS 39564-3421
Phone (251) 433-1895

2809 Denny Ave
Pascagoula, MS 39581-5301
Phone (228) 809-2254

6701 Airport Blvd
Suite B135
Mobile, AL 36608-3794
Phone (251) 433-1895

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.86 of 100Reported as group
Quality
77.71
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
86.88 of 100Reported as group
Quality
77.29
Promoting interoperability
100
Improvement activities
40
Cost
78.99

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Urology Associates of Mobile, P.a. CurrentSince Oct 1, 2022 Accepting new patients
Singing River Pathology PLLC CurrentSince May 1, 2019 Accepting new patients
Hub Care Pathology, P.a. Anatomic Pathology & Clinical Pathology PastSince Jun 1, 2007 Accepting new patients

Locations

6701 Airport Blvd
Ste B135
Mobile, AL 36608
Phone (251) 633-0573

168 Mobile Infirmary Blvd
Mobile, AL 36607
Phone (251) 633-3617

15200 Community Rd
Gulfport, MS 39503
Phone (228) 575-7000

5052 W 4th St
Ste 7
Hattiesburg, MS 39402

5052 W 4th St
Hattiesburg, MS 39402
Phone (601) 261-2587

1153 Ocean Springs Rd
Ocean Springs, MS 39564
Phone (228) 819-8586

3109 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 818-1100

2809 Denny Ave
Pascagoula, MS 39581
Phone (228) 809-5000

2525 Telephone Rd
Pascagoula, MS 39567
Phone (228) 762-4483

5700 Southwyck Blvd
Toledo, OH 43614

Organizations & group practices 3

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 63

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

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1295913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559520000000",
    "number": "1962707745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5052 W 4TH ST STE 7",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021069",
            "telephone_number": "601-261-2587",
            "fax_number": "601-264-7426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2809 DENNY AVE",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "39581",
            "telephone_number": "228-818-6063",
            "fax_number": "228-809-2254"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3109 Bienville Blvd",
            "address_purpose": "LOCATION",
            "city": "Ocean Springs",
            "state": "MS",
            "postal_code": "395644361",
            "country_code": "US",
            "telephone_number": "228-818-4056",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "LACEY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-25",
        "last_updated": "2019-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AL",
            "license": "MD.35922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pascagoula, MS

Sources for this page

Verify at the official NPI Registry.