Jerome P. Lacy, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

15898 Issued in KY

Practice address

6420 Dutchmans Pkwy
Suite 200
Louisville, KY 40205-3372

Phone

(502) 891-8300

Fax

(502) 891-8338

NPI assigned

May 23, 2006

Sex

Male

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 8

Medicare fee-for-service enrollment

Enrolled in KY

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Community Medical Associates, Inc.

  • Multi-Specialty Clinic/Center
  • Louisville, KY
  • NPI 1306983762
  Medicare reassignment NPD
• Community Medical Associates, Inc.

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1588614994
  NPD
• Community Medical Associates, Inc.

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1881192409
  NPD
• Norton Hospitals Inc

  • Cardiovascular Disease Physician
  • Louisville, KY
  • NPI 1295782332
  NPD (past)

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424736000000",
    "number": "1649225020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 950232",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402950232",
            "telephone_number": "502-891-8300",
            "fax_number": "502-891-8338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6420 DUTCHMANS PKWY",
            "address_2": "SUITE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402053372",
            "telephone_number": "502-891-8300",
            "fax_number": "502-891-8338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACY",
        "first_name": "JEROME",
        "middle_name": "P.",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2015-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "KY",
            "license": "15898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100388580A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT- CTS",
            "identifier": "50032166",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000044915",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100388580F",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "1056116",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT ADVANTAGE PIN",
            "identifier": "2433840000",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64158983",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA- CTS",
            "identifier": "4012633",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana Lynn Lackey, MD
• Nicholas John Laco, DPM
• Channing Lacour
• Abra Marcum Lacy
• Alicia Lacy
• John McPherson Lacy, PH.D.
• William Owen Lacy, MD
• Sagan Lee Ladd, MA, LPA
• Ladies & Gentlemen of Promise Inc
• Ladies of Promises Inc.

• Cardiovascular Disease Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Cardiovascular Disease Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; 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.