NPIMap

Individual provider Active NPI

Clark Lachcik, PA-C

  • Physician Assistant
  • Melbourne, FL
National Provider Identifier
1225430879
Registry record updated Nov 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9108265 Issued in FL
Practice address
1775 W Hibiscus Blvd
Suite 215
Melbourne, FL 32901-2620
Phone
(321) 837-3820
NPI assigned
Sep 25, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2016

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 PA9108265 FL Primary

Addresses

Primary practice location

1775 W Hibiscus Blvd
Suite 215
Melbourne, FL 32901-2620

Mailing address

1470 Paradise CT
Merritt Island, FL 32952-5560
Phone (321) 446-0689

Other identifiers 1

IdentifierTypeStateIssuer
013828000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150112000648 FL Practitioner - Physician Assistant 7315261872 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MD Now Medical Centers IncGroup PAC ID 3971554825, 314 clinicians

Practice addresses (Care Compare)

1150 US Hwy 1
Vero Beach, FL 32960-5769
Phone (772) 978-5679

1801 NE Jensen Beach Blvd
(Mdnow Jensen Beach)
Jensen Beach, FL 34957-7233
Phone (772) 334-1700

1900 SE Port St Lucie Blvd
Port Saint Lucie, FL 34952-5554
Phone (772) 398-1588

4570 Lantana Rd
Lake Worth, FL 33463-6908
Phone (561) 963-9881

640 21St St
Vero Beach, FL 32960-0933
Phone (772) 299-1092

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9108265FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dwic of Tampa Bay, Inc. CurrentSince Feb 4, 2022 Accepting new patients
Medexpress Urgent Care of Boynton Beach, LLC CurrentSince Feb 14, 2022 Accepting new patients
Medexpress Urgent Care of Boynton Beach, LLC CurrentSince Feb 14, 2022 Accepting new patients
MD Now Medical Centers Inc CurrentSince Jan 15, 2024 Accepting new patients
Dwic of Tampa Bay, Inc. CurrentSince Feb 4, 2022 Accepting new patients
Orlando Health Medical Group Inc Past Accepting new patients
Dwic of Tampa Bay, Inc Past Accepting new patients

Locations

7593 Boynton Beach Blvd
Ste 190
Boynton Beach, FL 33437
Phone (561) 572-3200

8849 State Road 52
Hudson, FL 34667
Phone (727) 863-7150

4570 Lantana Rd
Lake Worth, FL 33463
Phone (305) 949-4141

1120 Homestead Rd N
Lehigh Acres, FL 33936
Phone (239) 303-5020

2810 W Mlk Blvd
Tampa, FL 33607
Phone (813) 289-6637

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1411603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479427200000",
    "number": "1225430879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1470 PARADISE CT",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329525560",
            "telephone_number": "321-446-0689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 W HIBISCUS BLVD",
            "address_2": "SUITE 215",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329012620",
            "telephone_number": "321-837-3820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACHCIK",
        "first_name": "CLARK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-25",
        "last_updated": "2016-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9108265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013828000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.