Laconia A Bacon (NPI# 1144628157, PAC ID# 9931428620) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1144628157 |
| PAC ID by PECOS | 9931428620 |
| Professional Enrollment ID | I20150430001678 |
| Full Name | Laconia A Bacon |
| Organization Legal Name | WOODROME MEDICAL PA |
| Address |
613 W Bluff Dogwood Family Clinic Woodville TX 75979-5125 |
| Phone Number | 4093311000 |
| Gender | F |
| Graduation Year | 2014 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 3476553579 |
| Number of Group Practice Members | 7 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 450395 | MEMORIAL MEDICAL CENTER LIVINGSTON |
| 450573 | CHRISTUS JASPER MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 1930 Us Hwy 190 W, Total Health and Wellness Clinic, Livingston, TX 77351-9600 | 9363279944 | WOODROME MEDICAL PA |
| 613 W Bluff, Dogwood Family Clinic, Woodville, TX 75979-5125 | 4093311000 | WOODROME MEDICAL PA |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| MIPS_EC_130_overall | Documentation of Current Medications in the Medical Record | 100% | |
| MIPS_EC_131_overall | Pain Assessment and Follow-Up | 100% |
| Organization Legal Name | WOODROME MEDICAL PA |
| Physicians | 7 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| David Alan Price | Physician Assistant | Woodrome Medical Pa | 1930 Us Hwy 190 W, Total Health and Wellness Clinic, Livingston, TX 77351-9600 |
| Robert G Woodrome | Family Medicine | Woodrome Medical Pa | 1930 Us Hwy 190 W, Total Health and Wellness Clinic, Livingston, TX 77351-9600 |
| Crissy Dawn Kicak | Nurse Practitioner | Woodrome Medical Pa | 1930 Us Hwy 190 W, Total Health and Wellness Clinic, Livingston, TX 77351-9600 |
| Kenneth M Fuller | Nurse Practitioner | Woodrome Medical Pa | 1930 Us Hwy 190 W, Total Health and Wellness Clinic, Livingston, TX 77351-9600 |
| Dayna Michelle Lobue | Nurse Practitioner | Woodrome Medical Pa | 1930 Us Hwy 190 W, Total Health and Wellness Clinic, Livingston, TX 77351-9600 |
| Andrew J Gulbis | Family Medicine | Woodrome Medical Pa | 1930 Us Hwy 190 W, Total Health and Wellness Clinic, Livingston, TX 77351-9600 |
| Street Address |
613 W BLUFF DOGWOOD FAMILY CLINIC |
| City | WOODVILLE |
| State | TX |
| Zip | 75979-5125 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Andrew D James | Optometry | 1003 N Pine St, Woodville, TX 75979-4115 | |
| Nicole M Ellison | Family Medicine | Tyler County Hospital District | 104 N Beech, Woodville, TX 75979-4718 |
| Risheng Xu | Internal Medicine | Tyler County Hospital District | 104 N Beech, Woodville, TX 75979-4718 |
| Paula L Denson | Family Medicine | Tyler County Hospital District | 104 N Beech, Woodville, TX 75979-4718 |
| Pramoda K Mohapatra | Family Medicine | Tyler County Hospital District | 104 N Beech, Woodville, TX 75979-4718 |
| Nalini S Baijnath | Family Medicine | Tyler County Hospital District | 104 N Beech, Woodville, TX 75979-4718 |
| Natalia Ivanova | Family Medicine | Tyler County Hospital District | 104 N Beech, Woodville, TX 75979-4718 |
| William P Williamson | Chiropractic | Wheeler Chiropractic and Sports Injury | 1101 W Bluff St, Woodville, TX 75979-4737 |
| Vien T Pham | Internal Medicine | Doucette Branch Inpatient Services Pllc | 1100 W Bluff St, Tyler County Hospital, Woodville, TX 75979-4738 |
| James W Kutchback | Podiatry | 1100 W Bluff, Woodville, TX 75979-4738 | |
| Find all physicians in zip 75979 | |||
| City | WOODVILLE |
| Zip Code | 75979 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | WOODVILLE + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Laconia A Bacon.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.