LACEY MEDICAL GROUP, LLC
NPI 1487091369
Family Medicine in Forked River, NJ
About Lacey Medical Group, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LACEY MEDICAL GROUP, LLC (NPI 1487091369) is a healthcare organization registered as a family medicine in Forked River, New Jersey and active in the NPI registry since May 2013. The organization holds a CLIA Waiver certificate valid through November 19, 2027 and lists Ann Dipaolo, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Lacey Medical Group, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Lacey Medical Group, LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 31D2069270
Lacey Medical Group, LLC · Forked River, NJFrequently 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 Medical Group, LLC's NPI number?
The NPI number for Lacey Medical Group, LLC is 1487091369. It was assigned to this organization in the NPPES registry on May 31, 2013.
Where is Lacey Medical Group, LLC located?
Lacey Medical Group, LLC is located at 1044 Lacey Rd Ste 9, Forked River, NJ 08731. The listed phone number is (609) 693-0819.
What is Lacey Medical Group, LLC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Lacey Medical Group, LLC enrolled in Medicare?
Yes. Lacey Medical Group, LLC is registered in the Medicare PECOS enrollment system.
When is Lacey Medical Group, LLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (New Jersey, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Lacey Medical Group, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Lacey Medical Group, LLC, in Family Practice and Nurse Practitioner. A 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 the clinician's services. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Lacey Medical Group, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 31D2069270) is associated with this NPI, valid through November 19, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Lacey Medical Group, LLC was last updated on October 12, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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 Medical Group, Llc · NPI 1487091369
Family Medicine organization in Forked River, New Jersey. Organization record, active in the CMS NPPES registry since May 31, 2013.
## Identity
- **NPI:** 1487091369 (Entity type: Organization)
- **Enumerated:** May 31, 2013
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Ann Dipaolo, OWNER
## Practice location
- **Address:** 1044 LACEY RD STE 9, Forked River, NJ 08731-1051
- **Phone:** (609) 693-0819 · **Fax:** (609) 971-0834
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, New Jersey, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (1), Nurse Practitioner (1); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 12, 2023
- **Other identifiers:** Medicaid 0052680 (NJ)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1487091369) · Data from the CMS NPPES public registry.