Lacey Zack, M.D.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

A116342 Issued in CA

Practice address

1245 Wilshire Blvd
Ste 607
Los Angeles, CA 90017-4806

Phone

(213) 338-1521

Fax

(213) 266-8183

NPI assigned

Jun 30, 2011

Last updated

Jan 6, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Lacey Mills Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Orthopedic SurgeryAlso: Sports Medicine

Education

University of Southern California Keck School of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lacey Zack MD IncGroup PAC ID 6608287156, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Radium Home Health Care Inc Home health agency, Glendale, CA, CCN 559473

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/18567/brand/1/csg/1/fhir/r4
• Direct secure messaging: lacey.zack.1@18567.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lacey Zack, MD Inc

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Los Angeles, CA
  • NPI 1205301397
  Medicare reassignment Care Compare group NPD Authorized official
• Pih Health Good Samaritan Hospital

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1508859323
  NPD (past)
• Good Samaritan Hospital of Suffern

  • General Acute Care Hospital
  • Suffern, NY
  • NPI 1346213469
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Radium Home Health Care, Inc

  • Home Health Agency
  • Glendale, CA
  • NPI 1407326796
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578268800000",
    "number": "1124315916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 WILSHIRE BLVD STE 607",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900174806",
            "telephone_number": "213-338-1521",
            "fax_number": "213-266-8183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 WILSHIRE BLVD",
            "address_2": "STE 607",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900174806",
            "telephone_number": "213-338-1521",
            "fax_number": "213-266-8183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZACK",
        "first_name": "LACEY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-30",
        "last_updated": "2020-01-06",
        "certification_date": "2020-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A116342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LACEY",
            "last_name": "MILLS",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Paige Kathleen Dekker Zachary, MD
• Latiera Zachery
• Corinne Elizabeth Zachry
• Zacoalco Medical Group Inc
• Zacoalco Urgent Care Center Inc
• Arash Zad-Behtooie
• Gabriel Zada, M.D.
• Sherehan Zada, MD

• Orthopaedic Surgery Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Orthopaedic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.