Lia Back, PA
Individual provider Active NPI Physician Assistant · Lexington, KY
NPI 1669486197 · NPPES record last updated May 24, 2023
Key facts
- NPI
- 1669486197
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA435 (KY)
- Practice address
- 1221 S Broadway
Lexington, KY 40504-2701 - Phone
- (859) 258-4000
- Fax
- (859) 258-6203
- NPI assigned
- Jul 28, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 12
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Concord Medical Group of Kentucky PLLC
Practice addresses (Care Compare)
210 Marie Langdon Dr
Manchester, KY 40962-6388
Phone (606) 598-5104
Hospital & facility affiliations
- Saint Joseph London
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY, IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041012000265 | KY | Practitioner - Physician Assistant | 1951361302 | Reassigns benefits to 3 organizations |
| I20141029001379 | IN | Practitioner - Physician Assistant | 1951361302 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA435 | KY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Lexington Clinic, PSC | Current |
Accepting new patients | |
| Tristate Pathology and Forensic Services LLC | Current | Accepting new patients | |
| Primary Care Centers of Eastern Kentucky, LLC | Current |
Accepting new patients | |
| Concord Medical Group of Kentucky PLLC | Current |
Accepting new patients | |
| Primary Care Centers of Eastern Kentucky, LLC | Current | Accepting new patients | |
| New Lexington Clinic PSC | Current |
Accepting new patients | |
| Primary Care Centers of Eastern Kentucky, LLC | Current |
Accepting new patients | |
| Primary Care Centers of Eastern Kentucky, LLC | Current | Accepting new patients | |
| Primary Care Centers of Eastern Kentucky, LLC | Current | Accepting new patients | |
| Norton - Kings Daughters Health Inc | Physician Assistant | Current |
Accepting new patients |
Locations
1373 N State Road 62
Madison, IN 47250
Phone (812) 801-0196
445 Clifty Dr
Madison, IN 47250
Phone (812) 273-5372
1700 Old Lebanon Rd
Campbellsvlle, KY 42718
Phone (270) 465-3561
145 Citizens Ln
Ste B
Hazard, KY 41701
Phone (606) 439-1300
101 Town and Country Ln
#100
Hazard, KY 41701
Phone (606) 439-1300
425 Hindman Byp
Hindman, KY 41822
Phone (606) 785-1300
21992 Main St
Hyden, KY 41749
Phone (606) 672-5200
1221 S Broadway
Lexington, KY 40504
Phone (859) 258-4181
1 Saint Joseph Dr
Lexington, KY 40504
Phone (502) 350-5000
150 N Eagle Creek Dr
Lexington, KY 40509
Phone (859) 267-9773
210 Marie Langdon Dr
Manchester, KY 40962
Phone (865) 985-7047
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/HCJFBA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA435 | KY | Yes |
Addresses
Primary practice location
1221 S Broadway
Lexington, KY 40504-2701
Mailing address
1221 S Broadway
Lexington, KY 40504-2701
Phone (859) 258-6200
Other practice location 1
145 Citizens Ln
Hazard, KY 41701-1320
Phone (606) 439-1300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 412840162 | Other | IN | MEDICARE |
| 7100097340 | Medicaid | KY | |
| 300026152 | Medicaid | IN |
Other providers in Lexington, KY
- Sara Bachert
- Harrison Bachmeier
- Paul Bachner
- Back Talk Chiropractic PSC
- Brittany Bianca Back
- Treven Back
- W Douglas Back
- Carl Lewis Backer
- Mircea Backhurst
- James David Bacon
All providers in Lexington, KY · Physician Assistant in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.