NPIMap

Individual provider Active NPI

Lacey Michelle Harvey, PA-C

  • Physician Assistant
  • Huntertown, IN
National Provider Identifier
1295207488
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10002642A Issued in IN
Practice address
PO Box 670
Huntertown, IN 46748-0670
Phone
(260) 748-3650
Fax
(260) 748-3651
NPI assigned
Dec 28, 2018
Last updated
Aug 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 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 10002642A IN Primary

Addresses

Primary practice location

PO Box 670
Huntertown, IN 46748-0670

Mailing address

PO Box 670
Huntertown, IN 46748-0670
Phone (260) 748-3650

Other names 1

  • Lacey Michelle Lopez Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20190109002150 IN Practitioner - Physician Assistant 8628314853 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Radiology P CGroup PAC ID 0143295410, 101 clinicians

Practice addresses (Care Compare)

5001 US Hwy 30 W D
Fort Wayne, IN 46818-9701
Phone (260) 432-1568

7601 W Jefferson
Fort Wayne Orthopaedics
Fort Wayne, IN 46804-4133
Phone (260) 436-8686

7631 W Jefferson Blvd
Fort Wayne, IN 46804-4133
Phone (260) 436-7770

7900 W Jefferson Blvd
104 Interventional Clinic
Fort Wayne, IN 46804-4128
Phone (260) 435-7951

7950 W Jefferson Blvd
Lutheran Hospital of Fort Wayne
Fort Wayne, IN 46804-4140
Phone (260) 435-7001

7952 W Jefferson Blvd
Orthopaedic Hospital of Lutheran Network
Fort Wayne, IN 46804-4140
Phone (260) 435-7001

7956 W Jefferson Blvd
120 Allied Imaging II
Fort Wayne, IN 46804-4140
Phone (260) 436-2416

7970 W Jefferson Blvd
Rehabilitation Hospital of Fort Way
Fort Wayne, IN 46804-4140
Phone (260) 435-6142

7988 W Jefferson Blvd
Summit Radiology/Womens Health Adva
Fort Wayne, IN 46804-4140
Phone (260) 432-1568

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.96 of 100Reported as group
Quality
92.18
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10002642AINMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Racc Medical Associates LLC CurrentSince Dec 14, 2018 Accepting new patients
Orthopaedics Northeast PC CurrentSince Jul 29, 2024 Accepting new patients
Orthopaedics Northeast PC CurrentSince Jul 29, 2024 Accepting new patients

Locations

1314 E 7th St
Ste 201
Auburn, IN 46706
Phone (260) 927-0400

1721 Magnavox Way
Fort Wayne, IN 46804
Phone (260) 250-0001

5050 N Clinton St
Fort Wayne, IN 46825
Phone (219) 484-8551

5052 N Clinton St
Fort Wayne, IN 46825
Phone (260) 408-2203

Organizations & group practices 4

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1545955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1295207488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 670",
            "city": "HUNTERTOWN",
            "state": "IN",
            "postal_code": "467480670",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 670",
            "city": "HUNTERTOWN",
            "state": "IN",
            "postal_code": "467480670",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARVEY",
        "first_name": "LACEY",
        "middle_name": "MICHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-28",
        "last_updated": "2024-08-05",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10002642A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LACEY",
            "last_name": "LOPEZ",
            "middle_name": "MICHELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Huntertown, IN

Sources for this page

Verify at the official NPI Registry.