NPIMap

Individual provider Active NPI

Lacy Manuelito, MD

  • Pediatrics Physician
  • Sacaton, AZ
National Provider Identifier
1750844155
Registry record updated Sep 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
65759 Issued in AZ
Practice address
483 W Seed Farm Rd
Sacaton, AZ 85147-5000
Phone
(602) 528-1200
Fax
(602) 528-1255
NPI assigned
Apr 11, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 65759 AZ Primary

Addresses

Primary practice location

483 W Seed Farm Rd
Sacaton, AZ 85147-5000

Mailing address

PO Box 38
Sacaton, AZ 85147-0001
Phone (602) 528-1200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20221005000749 TX Practitioner - Pediatric Medicine 3870820210 Reassigns benefits to 5 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ton Santa Rosa Health Center CurrentSince Aug 26, 2022 Accepting new patients
Ton San Xavier Health Center CurrentSince Aug 26, 2022 Accepting new patients
Ton Sells Hospital CurrentSince Aug 26, 2022 Accepting new patients
Gila River Health Care Corporation Current Accepting new patients
Gila River Health Care CurrentSince Aug 25, 2025 Accepting new patients
Ton San Simon Health Center CurrentSince Aug 26, 2022 Accepting new patients
Gila River Health Care CurrentSince Aug 25, 2025 Accepting new patients
Gila River Health Care Corporation Current Accepting new patients
Ton Santa Rosa Health Center Past Accepting new patients
Ton San Xavier Health Center Past Accepting new patients
Ton Sells Hospital Past Accepting new patients
University of Arizona Past Accepting new patients

Locations

17487 S Healthcare Dr
Laveen, AZ 85339
Phone (520) 550-6000

17487 S Healthcare Dr
#H
Laveen, AZ 85339
Phone (520) 550-6000

7900 S J Stock Rd
Tucson, AZ 85746
Phone (520) 295-2550

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759190400000",
    "number": "1750844155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 38",
            "city": "SACATON",
            "state": "AZ",
            "postal_code": "851470001",
            "telephone_number": "602-528-1200",
            "fax_number": "602-528-1255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "483 W SEED FARM RD",
            "city": "SACATON",
            "state": "AZ",
            "postal_code": "851475000",
            "telephone_number": "602-528-1200",
            "fax_number": "602-528-1255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANUELITO",
        "first_name": "LACY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-11",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "65759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacaton, AZ

Sources for this page

Verify at the official NPI Registry.