Andrea Lynne Lacki, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

MA053507 Issued in PA

Practice address

3000 Fairway Dr
Altoona, PA 16602-4472

Phone

(814) 962-1166

NPI assigned

Mar 30, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• University Orthopedics Center, LTD

  • Orthopaedic Surgery Physician
  • State College, PA
  • NPI 1770500415

  Physician Assistant

  NPD
• University Orthopedics Center, LTD

  • Durable Medical Equipment & Medical Supplies
  • Johnstown, PA
  • NPI 1902417157
  NPD
• Windber Hospital, Inc.

  • General Acute Care Hospital
  • Windber, PA
  • NPI 1275620536
  NPD (past)

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273104000000",
    "number": "1215057799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 N TERRACE DR",
            "city": "ALTOONA",
            "state": "PA",
            "postal_code": "166022965",
            "telephone_number": "814-441-4861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 FAIRWAY DR",
            "city": "ALTOONA",
            "state": "PA",
            "postal_code": "166024472",
            "telephone_number": "814-962-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACKI",
        "first_name": "ANDREA",
        "middle_name": "LYNNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2010-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MD",
            "license": "C0003589",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110002349",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA053507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cory Allen Kutruff, DO
• Alexis Noelle Kutz
• Ann M Kveragas, RN
• Jong Kwon, MD
• Barbara Labban
• Lafa Transportation LLC
• Melissa Lafferty, PA
• Erin Marie Laich, BS
• Richard Laino
• Julia M Laird, PHARM.D.

• Surgical Physician Assistant in Altoona, PA
• Providers in Altoona, PA by specialty
• Surgical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2010; 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.

Verify at the official NPI Registry.