Jeffrey L Lackore, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110001943 Issued in VA

Practice address

6120 Sandhurst Dr
Roanoke, VA 24018-7798

Phone

(712) 253-6104

NPI assigned

Jul 8, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Merit-based Incentive Payment System (MIPS)

Final score

97.92 of 100Reported as group

Quality

87.42

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: jlackore227529@hisp.ehr.sutterhealth.org

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.

• Sonoma Valley Emergency Physicians Medical Group, Inc

  • Emergency Medicine Physician
  • Sonoma, CA
  • NPI 1710164629
  Medicare reassignment
• Vallejo Emergency Physicians Medical Group Inc.

  • Emergency Medicine Physician
  • Vallejo, CA
  • NPI 1083916373
  Medicare reassignment
• Woodland Emergency Physicians Medical Group Inc

  • Emergency Medicine Physician
  • Woodland, CA
  • NPI 1881868164
  Medicare reassignment

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251072000000",
    "number": "1306879192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6120 SANDHURST DR",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240187798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6120 SANDHURST DR",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240187798",
            "telephone_number": "712-253-6104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACKORE",
        "first_name": "JEFFREY",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2009-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110001943",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA20332",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306879192",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laboratory Corporation of America Holdings
• Laboratory Corporation of America Holdings
• Laboratory Corporation of America Holdings
• Laboratory Corporation of America Holdings
• Bethany Lackey, LPC
• Joanna Marie Lacroix
• Edward Ladyzhenskiy, M.D.
• Charles T Lafferty, DO
• Nitu Kaur Lahar
• Lindsay Laing, DDS

• Physician Assistant in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2009; 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.