Lacie Shae Burge, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71007164A Issued in IN

Practice address

400 South Oak Street
Randolph Medical Center
Winchester, IN 47394

Phone

(765) 584-6600

Fax

(765) 584-6503

NPI assigned

Mar 4, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Lacie Masters Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians

Indiana University Health Ball Memorial Physicians IncGroup PAC ID 9537072640, 286 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Indiana University Health Ball Memorial Hospital Hospital, Muncie, IN, CCN 150089
• Indiana University Health Hospital, Indianapolis, IN, CCN 150056

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lburge301962@reidhealth.direct-ci.com
• Direct secure messaging: lburge@direct.iuhealth.org

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.

• Indiana University Health Ball Memorial Physicians, Inc.

  • Family Medicine Physician
  • Muncie, IN
  • NPI 1235455544

  IN

  Medicare reassignment Care Compare group NPD
• Iu Health Medical Group, LLC

  • General Practice Physician
  • Indianapolis, IN
  • NPI 1326893777

  Family, IN

  Medicare reassignment Care Compare group NPD

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

• Indiana University Health Ball Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Muncie, IN
  • NPI 1225195340

  Hospital

  Care Compare affiliation
• Indiana University Health Inc

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1144266024

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1488585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1972043305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 REID PARKWAY",
            "address_2": "MEDICAL STAFF SERVICES",
            "city": "RICHMOND",
            "state": "IN",
            "postal_code": "47374",
            "telephone_number": "765-584-6600",
            "fax_number": "765-584-6503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 SOUTH OAK STREET",
            "address_2": "RANDOLPH MEDICAL CENTER",
            "city": "WINCHESTER",
            "state": "IN",
            "postal_code": "47394",
            "telephone_number": "765-584-6600",
            "fax_number": "765-584-6503"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2901 W Jackson St",
            "address_purpose": "LOCATION",
            "city": "Muncie",
            "state": "IN",
            "postal_code": "473044307",
            "country_code": "US",
            "telephone_number": "765-747-4332",
            "fax_number": "765-448-7689",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9180 W 500 N",
            "address_purpose": "LOCATION",
            "city": "Farmland",
            "state": "IN",
            "postal_code": "473409298",
            "country_code": "US",
            "telephone_number": "765-509-0408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURGE",
        "first_name": "LACIE",
        "middle_name": "SHAE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-04",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71007164A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD PTAN",
            "identifier": "P02622733",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "224040161",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lburge301962@ReidHealth.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Reid Physician Associates, Inc.",
            "address_1": "400 South Oak Street",
            "address_2": "Randolph Medical Center",
            "city": "Winchester",
            "state": "IN",
            "country_code": "US",
            "postal_code": "47394",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lburge@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2901 W Jackson St",
            "city": "Muncie",
            "state": "IN",
            "country_code": "US",
            "postal_code": "473044307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LACIE",
            "last_name": "MASTERS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mindy Lyn Betts, PTA
• Arthur R Boerner, MD PSC
• Savannah Grace Brewer
• Evan Bruggeman
• Madalynn Buckingham
• Kelly J Campbell, FNP
• Cardinal Health Systems
• Mabrey Jen Chamberlin, CNM
• Thomas N Chapin, D.O.
• Tonia Childers, MA

• All providers in Winchester, IN
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; 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.