Courtney N Laczko, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA059099 Issued in PA

Practice address

3535 Pentagon Blvd
Beavercreek, OH 45431-1705

Phone

(937) 702-4503

Fax

(937) 702-4129

NPI assigned

May 1, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in PA, OH2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Allegheny ClinicGroup PAC ID 5395649586, 2,313 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• West Penn Hospital Hospital, Pittsburgh, PA, CCN 390090

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: claczko915888@direct.ahn.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.

• Allegheny Clinic

  • Family Medicine Physician
  • Bethel Park, PA
  • NPI 1073081493
  Medicare reassignment Care Compare group
• Alliance Physicians Inc

  • Family Medicine Physician
  • Kettering, OH
  • NPI 1437125572
  Medicare reassignment NPD
• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865
  Medicare reassignment
• Pulmonary & Critical Care Consultants, Inc

  • Pulmonary Disease Physician
  • Dayton, OH
  • NPI 1861432379
  Medicare reassignment
• Wellspan Medical Group

  • Gastroenterology Physician
  • York, PA
  • NPI 1669770004
  Medicare reassignment
• Alliance Physicians Inc

  • Family Medicine Physician
  • Beavercreek, OH
  • NPI 1891049722
  NPD
• Allegheny Clinic

  • Critical Care Medicine (Internal Medicine) Physician
  • Pittsburgh, PA
  • NPI 1063650919
  NPD
• Allegheny Clinic

  • Primary Care Clinic/Center
  • Pittsburgh, PA
  • NPI 1215752548
  NPD
• Wellspan Medical Group

  • Pediatric Surgery Physician
  • York, PA
  • NPI 1104799428
  NPD
• Wellspan Medical Group

  • Physical Therapist
  • Hagerstown, MD
  • NPI 1215515457
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• West Penn Allegheny Health System Inc

  • General Acute Care Hospital
  • Pittsburgh, PA
  • NPI 1194744805
  Care Compare affiliation
• West Penn Allegheny Health System Inc.

  • Oncology Clinic/Center
  • Pittsburgh, PA
  • NPI 1346489143

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1493596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1790210532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3588 SEQUOIA DR",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454313779",
            "telephone_number": "518-956-0372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 PENTAGON BLVD",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454311705",
            "telephone_number": "937-702-4503",
            "fax_number": "937-702-4129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACZKO",
        "first_name": "COURTNEY",
        "middle_name": "N",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-01",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA059099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "claczko774940@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3535 Pentagon Blvd",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454311705",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3535 Pentagon Blvd",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454311705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nikhil Tej Kurapati, MD, MPH
• Alisha Kusan, BCBA
• Tracey Kwiat, PAC
• Kyle R. Jackson, DDS, LLC
• Laboratory Corporation of America Holdings
• Lucis Ladden, PA-C
• Kimberly Lade
• Michaela Lamar, SLP
• Karen Marie Lampton, RN, BSN
• Kendal Janelle Landrum

• Physician Assistant in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; 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.