Amanda Elizabeth Lackey, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

2016018709 Issued in MO

Practice address

510 S Kingshighway Blvd
Dept Radiology
Saint Louis, MO 63110-1016

Phone

(314) 362-7200

Fax

(314) 747-4189

NPI assigned

Apr 20, 2010

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 identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO, IL2 enrollments

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 2

Specialty

Diagnostic Radiology

Education

Northeastern Ohio University College of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Specialists in Medical Imaging SCGroup PAC ID 2163733544, 228 clinicians

Blessing HospitalGroup PAC ID 3072422534, 414 clinicians

Breast Imaging of the Ozarks LLCGroup PAC ID 0244600146, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Blessing Hospital Hospital, Quincy, IL, CCN 140015
• Illini Community Hospital Hospital, Pittsfield, IL, CCN 141315

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.blessinghospital.com/R4/open-Prod

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.

• Breast Imaging of the Ozarks LLC

  • Diagnostic Radiology Physician
  • Springfield, MO
  • NPI 1417600412
  Medicare reassignment Care Compare group NPD
• Blessing Hospital

  • Multi-Specialty Clinic/Center
  • Quincy, IL
  • NPI 1114471737

  MO

  Medicare reassignment Care Compare group NPD
• Specialists in Medical Imaging, SC

  • Diagnostic Radiology Physician
  • Olympia Fields, IL
  • NPI 1841687951

  MO

  Medicare reassignment Care Compare group NPD
• Freeman-Oak Hill Health System

  • Multi-Specialty Clinic/Center
  • Joplin, MO
  • NPI 1679517023
  Medicare reassignment NPD
• Freeman-Oak Hill Health System

  • General Acute Care Hospital
  • Joplin, MO
  • NPI 1891809679
  Medicare reassignment NPD
• Miracl, LLC

  • Multi-Specialty Clinic/Center
  • Rolla, MO
  • NPI 1205304300
  Medicare reassignment NPD
• Washington University

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1962442475

  Diagnostic Radiology

  Medicare reassignment NPD
• Blessing Hospital

  • Rural Health Clinic/Center
  • Monroe City, MO
  • NPI 1013683507
  NPD

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

• Blessing Hospital

  • Nurse Practitioner
  • Quincy, IL
  • NPI 1417204827

  Hospital

  Care Compare affiliation
• Blessing Hospital

  • General Acute Care Hospital
  • Quincy, IL
  • NPI 1760571699
  Care Compare affiliation
• Blessingcare Corporation

  • Critical Access Hospital
  • Pittsfield, IL
  • NPI 1720086218
  Care Compare affiliation

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

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736380800000",
    "number": "1194041855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60352",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631600352",
            "telephone_number": "314-362-7200",
            "fax_number": "314-747-4189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 S KINGSHIGHWAY BLVD",
            "address_2": "DEPT RADIOLOGY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101016",
            "telephone_number": "314-362-7200",
            "fax_number": "314-747-4189"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1102 W 32nd St",
            "address_purpose": "LOCATION",
            "city": "Joplin",
            "state": "MO",
            "postal_code": "648043503",
            "country_code": "US",
            "telephone_number": "417-347-6611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LACKEY",
        "first_name": "AMANDA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-20",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2016018709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200033233",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "510 S Kingshighway Blvd",
            "address_2": "Dept Radiology",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Raizal Lacaya, FNP-BC
• Christina Lacey
• Joanne L. Lacey, MD
• Colleen Lachajczyk, LCSW
• Allison Lee Lacker, OTR/L
• Daniel Lackey, M.D.
• Julie M Lackey
• Susan M Lackey
• Timothy C Lackey, MD
• Carmenlita Lackland Montgomery

• Diagnostic Radiology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Diagnostic Radiology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2025; 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.