LACEY POE APRN
NPI 1205069630
Nurse Practitioner - Family in Manila, AR
About Lacey Poe Aprn NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LACEY POE APRN (NPI 1205069630) is an individual family provider in Manila, Arkansas, licensed in Arkansas (A03280) and active in the NPI registry since September 2009. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 4
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Lacey Poe Aprn is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Lacey Poe reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Lake City, AR 72347
- Reassigned Medicare billing, Arkansas enrollment
- 7 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 72442 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Referred Medical Equipment & Supplies CMS DME claims 4
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
Other Providers at the Same Location NPPES 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Poe's NPI number?
The NPI number for Lacey Poe is 1205069630. It was assigned to this individual provider in the NPPES registry on September 2, 2009.
Where is Lacey Poe located?
Lacey Poe practices at 3644 W St Hwy 18 Suite B, Manila, AR 72442. The listed phone number is (870) 561-3300.
What is Lacey Poe's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Lacey Poe enrolled in Medicare?
Yes. Lacey Poe is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Lacey Poe's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Lacey Poe reassigns Medicare benefits to Riverside Medical Clinic (Lake City, AR). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Lacey Poe's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Lacey Poe accept?
Health plans from Health Advantage and Octave list Lacey Poe as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Lacey Poe was last updated on February 18, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Lacey Poe, APRN · NPI 1205069630
Family physician in Manila, Arkansas. Individual provider, active in the CMS NPPES registry since September 2, 2009.
## Identity
- **NPI:** 1205069630 (Entity type: Individual)
- **Enumerated:** September 2, 2009
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** A03280 (Arkansas)
- **Sole proprietor:** No
## Practice location
- **Address:** 3644 W ST HWY 18, SUITE B, Manila, AR 72442
- **Phone:** (870) 561-3300 · **Fax:** (870) 561-3307
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Riverside Medical Clinic (NPI 1811206923, Lake City, AR), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 18, 2014
- **Other identifiers:** Medicaid 179499758 (AR); Medicare PIN 4A2167297 (AR); Medicare PIN 57297 (AR); and 1 more
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Source: [NPI Profile](https://npiprofile.com/npi/1205069630) · Data from the CMS NPPES public registry.