KEVIN LACK P.A.-C
NPI 1417924028
Physician Assistant - Surgical in Augusta, GA

Q: What is Kevin Lack's NPI number?

The NPI number for Kevin Lack is 1417924028. It was assigned to this individual provider in the NPPES registry on March 2, 2006.

Q: What is Kevin Lack's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Q: When was this NPI record last updated?

The NPPES record for Kevin Lack was last updated on March 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 02, 2006PECOS EnrolledAccepts Medicare Assignment

3675 J DEWEY GRAY CIRCLE, SUITE 300, AUGUSTA, GA 30909(706) 863-9595(888) 745-3917 Get Directions Write a Review

NPPES record last updated: March 10, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 10, 2025, May 5, 2022, Mar 23, 2021 and 1 more (4 updates tracked since 2020).

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About Kevin Lack P.a.-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KEVIN LACK P.A.-C (NPI 1417924028) is an individual surgical provider in Augusta, Georgia, licensed in Georgia (4292) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS, is affiliated with Doctors Hospital, and maintains a secondary practice location in Augusta.

NPPES Registry Identity

NPI1417924028

Entity TypeIndividualMale

Primary Taxonomy363AS0400X

Provider Legal NameKEVIN LACKCredential: P.A.-C

Location Address3675 J DEWEY GRAY CIRCLE, SUITE 300Augusta, GA 30909-1868

Mailing AddressPo Box 3726Augusta, GA 30914-3726 · (706) 863-9595 · Fax (888) 745-3917

Phone(706) 863-9595

Fax(888) 745-3917

Sole ProprietorNo

Medical School CMSOtherGraduated 2004

Enumeration DateMarch 2, 2006

Last NPPES UpdateMarch 10, 20254 updates tracked since enumeration

NPPES CertifiedMarch 10, 2025

✔ NPI 1417924028 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AS0400X

Licenses✔ Licensed in GA · 4292✔ Licensed in ID · PA-1765✔ Licensed in SC · PA1198✔ Licensed in TN · PA0000001669✔ Licensed in FL · PA9106353

3675 J DEWEY GRAY CIRCLE, Augusta, GA 30909

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Secondary Practice Location 1

Location 13651 Wheeler RdAugusta, GA 30909-6521 · Phone (706) 863-9595

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BlueCross BlueShield of South Carolina, Moda Health Plan, Inc., Molina Healthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kevin Lack P.a.-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5890754147

PECOS Enrollment IDI20041004000710

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Preparation of skin graft site of trunk, arms, or legs, each additional 100.0 sq cm or 1% body area for infants and children, or less 15003

This procedure involves preparing a specific area of your body (trunk, arms, or legs) for a skin graft. The area is cleaned and treated to receive new skin, usually to aid in healing from a burn or wound. The size of the area treated is up to 100.0 sq cm or 1% of a child's body area.

337 services22 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

45 services17 patients

Preparation of skin graft site of trunk, arms, or legs, 100.0 sq cm or 1% body area for infants and children, or less 15002

This procedure involves preparing a specific area of the body (trunk, arms, or legs) for a skin graft. The area is cleaned and any dead tissue is removed to ensure a successful graft. The procedure covers an area of 100.0 sq cm or 1% of a child's body.

36 services34 patients

Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less 15004

This procedure involves preparing a specific area of your body, such as the face, scalp, neck, or extremities, for a skin graft. A skin graft is a surgical procedure where healthy skin is transferred to an area of the body that has lost skin. This preparation ensures the graft will take hold effectively.

21 services21 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Doctors Hospital

Acute Care Hospitals · Augusta, GA

3/5 CMS rating

OwnershipProprietary

CMS Certification Number110177

Location3651 Wheeler RoadAugusta, GA 30909 · Richmond County

Emergency services Birthing friendly

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Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JUAN L COLON-SANTINI M.D.

Pediatrics