Timothy C Lackey, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

103240 Issued in MO

Practice address

3555 Sunset Office Dr
Suite 101
Saint Louis, MO 63127-1015

Phone

(314) 966-0252

NPI assigned

May 25, 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 1

Medicare fee-for-service enrollment

Enrolled in MO, IL2 enrollments

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 2

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.

• SSM Cardinal Glennon Childrens Hospital

  • Pediatrics Physician
  • Saint Louis, MO
  • NPI 1073568226

  IL

  Medicare reassignment NPD
• SSM Cardinal Glennon Childrens Hospital

  • Pediatrics Physician
  • O Fallon, IL
  • NPI 1174577670

  MO

  Medicare reassignment NPD
• SSM Health Care St Louis

  • Emergency Medicine Physician
  • Fenton, MO
  • NPI 1275586174
  Medicare reassignment
• SSM Cardinal Glennon Children'S Hospital

  • Pediatrics Physician
  • Warrenton, MO
  • NPI 1962573212
  NPD
• SSM Health Care St. Louis

  • Emergency Medicine Physician
  • Saint Charles, MO
  • NPI 1427002922

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359936000000",
    "number": "1679529382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 SUNSET OFFICE DR",
            "address_2": "SUITE 107",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271015",
            "telephone_number": "314-822-5914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 SUNSET OFFICE DR",
            "address_2": "SUITE 101",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271015",
            "telephone_number": "314-966-0252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACKEY",
        "first_name": "TIMOTHY",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2013-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "103240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209684513",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allison Lee Lacker, OTR/L
• Amanda Elizabeth Lackey, MD
• Daniel Lackey, M.D.
• Julie M Lackey
• Susan M Lackey
• Carmenlita Lackland Montgomery
• Michelle Christine Lackner
• Norbert Lackner, RPH
• Laclede Groves
• Katrina Lacombe, MA, LPC, ATR

• Pediatrics Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2013; 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.