LACEY JEAN WILDEBOER PA
NPI 1477077089
Physician Assistant in Kenly, NC

Q: What is Lacey Wildeboer's NPI number?

The NPI number for Lacey Wildeboer is 1477077089. It was assigned to this individual provider in the NPPES registry on July 26, 2017.

Q: What is Lacey Wildeboer's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Lacey Wildeboer was last updated on October 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months 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.

Active since July 26, 2017PECOS EnrolledAccepts Medicare Assignment

400 N ENGLEWOOD DR, KENLY, NC 27542(919) 284-4149(919) 284-6008 Get Directions Write a Review

NPPES record last updated: October 3, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 16, 2022, Oct 20, 2020, Jul 26, 2017 (3 updates tracked since 2017).

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About Lacey Jean Wildeboer Pa NPPES

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

LACEY JEAN WILDEBOER PA (NPI 1477077089) is an individual physician assistant in Kenly, North Carolina, licensed in North Carolina (0010-07379) and active in the NPI registry since July 2017. She is enrolled in Medicare PECOS, is affiliated with Johnston Health, and maintains a secondary practice location in Knightdale.

NPPES Registry Identity

NPI1477077089

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameLACEY JEAN WILDEBOERCredential: PA

Location Address400 N ENGLEWOOD DRKenly, NC 27542-9290

Mailing Address5221 Paramount Pkwy Ste 220Morrisville, NC 27560-5490 · (984) 215-4111

Phone(919) 284-4149

Fax(919) 284-6008

Sole ProprietorNo

Medical School CMSOtherGraduated 2017

Enumeration DateJuly 26, 2017

Last NPPES UpdateOctober 3, 20253 updates tracked since enumeration

NPPES CertifiedOctober 3, 2025

✔ NPI 1477077089 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in NC · 0010-07379

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

400 N ENGLEWOOD DR, Kenly, NC 27542

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Secondary Practice Location 1

Location 17201 US Highway 64 EKnightdale, NC 27545-9268 · Phone (919) 266-7600

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC, UnitedHealthcare.Insurance ›

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

Lacey Jean Wildeboer Pa 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 ID8729351234

PECOS Enrollment IDI20170905003367

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.

Hospital Affiliations CMS Care Compare 2

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

Johnston Health

Acute Care Hospitals · Smithfield, NC

3/5 CMS rating

OwnershipGovernment - Hospital District or Authority

CMS Certification Number340090

Location509 Bright Leaf BlvdSmithfield, NC 27577 · Johnston County

Emergency services Birthing friendly

Rex Hospital

Acute Care Hospitals · Raleigh, NC

5/5 CMS rating

OwnershipGovernment - State

CMS Certification Number340114

Location4420 Lake Boone TrailRaleigh, NC 27607 · Wake County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 27542 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

$83.90 typical visit price

range $54.12 – $165.09

Typical copayment $20.97 (range $13.53 – $41.27)

Most-billed visit code 99203

Established Patient

$67.72 typical visit price

range $17.21 – $134.61

Typical copayment $16.93 (range $4.30 – $33.65)

Most-billed visit code 99213

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.

Reported Quality Measures

Breast Cancer Screening

Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer

7%54 patients1/55-star benchmark: 92%

Colorectal Cancer Screening

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

6%114 patients1/55-star benchmark: 85%

Documentation of Current Medications in the Medical Record

Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.

97%288 patients4/55-star benchmark: 100%

Medication Reconciliation

The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.

91%81 patients3/55-star benchmark: 100%

Patient-Specific Education

The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.

59%225 patients3/55-star benchmark: 97%

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user

Patients screenedForUse: 71% · 100 patients

57%88 patients3/55-star benchmark: 98%

Provide Patient Access

At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…

53%225 patients3/55-star benchmark: 100%

Secure Messaging

For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…

2%225 patients1/55-star benchmark: 89%

Use of High-Risk Medications in the Elderly

Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication.

Lower rates are better for this measure.

Patients 2+: 0% · 183 patients

0%183 patients5/55-star benchmark: 100%

View, Download, or Transmit (VDT)

At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.

21%225 patients

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Other Providers at the Same Location NPPES 5

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

JOHNSTON MEMORIAL HOSPITAL

Clinic/Center