Active NPI
Eileen Anne Lazecko, PA-C
- Physician Assistant
- Wilmington, NC
National Provider Identifier
1063801793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-05397
- Practice address
- 2800 Ashton Dr
Wilmington, NC 28412-2575 - Phone
- (910) 794-8895
- NPI assigned
- Jan 19, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0010-05397 | NC | Primary |
Addresses
Primary practice location
2800 Ashton Dr
Wilmington, NC 28412-2575
Mailing address
527 Commons Way
Wilmington, NC 28409-9189
Phone (815) 715-3733
Other practice location 1
1509 Doctors Cir Bldg C
Wilmington, NC 28401-7403
Phone (910) 662-7500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063801793 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010-05397 | NC | MD | Physician Assistant |
Interoperability endpoints
- elazecko1248430@direct.novanthealth.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Anesthesiology Physician
- Greenville, NC
- NPI 1205996519
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786924800000",
"number": "1063801793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "527 COMMONS WAY",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284099189",
"telephone_number": "815-715-3733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 ASHTON DR",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284122575",
"telephone_number": "910-794-8895"
}
],
"practiceLocations": [
{
"address_1": "1509 Doctors Cir Bldg C",
"address_purpose": "LOCATION",
"city": "Wilmington",
"state": "NC",
"postal_code": "284017403",
"country_code": "US",
"telephone_number": "910-662-7500",
"fax_number": "910-662-7501",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LAZECKO",
"first_name": "EILEEN",
"middle_name": "ANNE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-19",
"last_updated": "2026-08-17",
"certification_date": "2026-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-05397",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1063801793",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.