MRS. LACEY DIVELY MOY MD
NPI 1013144021
Family Medicine in Springfield, IL

Active since June 17, 2009PECOS EnrolledAccepts Medicare Assignment
72.14/100
CMS Quality Rating
3220 ATLANTA ST, SPRINGFIELD, IL 62707(217) 588-7400(217) 588-7439 Get Directions Write a Review

NPPES record last updated: May 16, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mrs. Lacey Dively Moy Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. LACEY DIVELY MOY MD (NPI 1013144021) is an individual family medicine provider in Springfield, Illinois, licensed in Illinois (036129248) and active in the NPI registry since June 2009. She is enrolled in Medicare PECOS, is affiliated with St Johns Hospital, and is a graduate of Rush Medical College Of Rush University (2009).

NPPES Registry Identity

NPI1013144021
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameMRS. LACEY DIVELY MOYCredential: MD
Location Address3220 ATLANTA STSpringfield, IL 62707-8801
Mailing Address3220 Atlanta StSpringfield, IL 62707-8801 · (217) 588-7400 · Fax (217) 588-7439
Fax(217) 588-7439
Sole ProprietorNo
Medical School CMSRush Medical College Of Rush UniversityGraduated 2009
Enumeration DateJune 17, 2009
Last NPPES UpdateMay 16, 2023
NPPES CertifiedMay 16, 2023
NPI 1013144021 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License Licensed in IL · 036129248
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
3220 ATLANTA ST, Springfield, IL 62707

Other Names 1

Former Name (1)Ms. Lacey M Dively M.d.

Other Identifiers 1

Other036.129248IL · Md License

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Mrs. Lacey Dively Moy Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7618138413
PECOS Enrollment IDI20120420000378
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
177 services111 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
94 services67 patients
Hemoglobin a1c level, by device for home use 83037
A Hemoglobin A1c device for home use allows you to check your average blood sugar levels over the past 3 months. It's a simple, painless test that provides immediate results, helping you manage your diabetes more effectively.
23 services15 patients
Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677
The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.
19 services19 patients
Administration of pneumococcal vaccine G0009
The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.
19 services19 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
17 services17 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Johns Hospital

Acute Care Hospitals · Springfield, IL
3/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number140053
Location800 E Carpenter StSpringfield, IL 62769 · Sangamon County
Emergency services Birthing friendly

Memorial Medical Center

Acute Care Hospitals · Springfield, IL
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140148
Location701 N First StSpringfield, IL 62702 · Sangamon County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62707 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$97.25 typical visit price
range $17.16 – $136.56
Typical copayment $24.31 (range $4.29 – $34.14)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

72.14/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality74.96
Improvement Activities40
Cost53.06

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
6 suppliers24 claims57 services$5.23 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner (Family)
3220 ATLANTA ST
SPRINGFIELD, IL 62707
Family Medicine
3220 ATLANTA ST
SPRINGFIELD, IL 62707
Nurse Practitioner (Family)
3220 ATLANTA ST
SPRINGFIELD, IL 62707
Nurse Practitioner (Primary Care)
3220 ATLANTA ST
SPRINGFIELD, IL 62707
Nurse Practitioner (Family)
3220 ATLANTA ST
SPRINGFIELD, IL 62707
Nurse Practitioner (Family)
3220 ATLANTA ST
SPRINGFIELD, IL 62707
Counselor (Professional)
3220 ATLANTA ST
SPRINGFIELD, IL 62707
Nurse Practitioner (Family)
3220 ATLANTA ST
SPRINGFIELD, IL 62707

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lacey Moy's NPI number?

The NPI number for Lacey Moy is 1013144021. It was assigned to this individual provider in the NPPES registry on June 17, 2009. The provider is also known as Ms. Lacey M Dively M.D..

Where is Lacey Moy located?

Lacey Moy practices at 3220 Atlanta St, Springfield, IL 62707. The listed phone number is (217) 588-7400.

What is Lacey Moy's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Lacey Moy enrolled in Medicare?

Yes. Lacey Moy is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Lacey Moy affiliated with any hospitals?

According to CMS data, Lacey Moy is affiliated with St Johns Hospital and Memorial Medical Center.

When was this NPI record last updated?

The NPPES record for Lacey Moy was last updated on May 16, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.