Individual provider Active NPI

Marissa Catherine Lacey, PA

  • Physician Assistant
  • Mansfield, OH
National Provider Identifier
1144862566
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.006183RX Issued in OH
Practice address
335 Glessner Ave
Mansfield, OH 44903-2269
Phone
(419) 522-2734
NPI assigned
Oct 17, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.006183RX OH Primary

Addresses

Primary practice location

335 Glessner Ave
Mansfield, OH 44903-2269

Mailing address

5450 Frantz Rd Ste 360
Dublin, OH 43016-4141

Other names 1

  • Marissa Zink Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191121003000 OH Practitioner - Physician Assistant 1557793049 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
80.04 of 100Reported as group
Quality
58.67
Promoting interoperability
98
Improvement activities
40
Cost
76.46

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50.006183RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ohiohealth Corporation CurrentSince Jan 1, 2021 Accepting new patients

Locations

393 E Town St
Ste 116
Columbus, OH 43215
Phone (614) 566-9108

5450 Frantz Rd
Ste 360
Dublin, OH 43016
Phone (614) 533-6497

335 Glessner Ave
Mansfield, OH 44903
Phone (419) 522-0320

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1571270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1144862566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5450 FRANTZ RD STE 360",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430164141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 GLESSNER AVE",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449032269",
            "telephone_number": "419-522-2734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACEY",
        "first_name": "MARISSA",
        "middle_name": "CATHERINE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-17",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.006183RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "ZINK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mansfield, OH

Sources for this page

Verify at the official NPI Registry.