1. Home
  2. Directory
  3. California
  4. Los Angeles
  5. Physician Assistant
  6. NPI Profile

MR. JON CHARLES LACY PA
NPI 1588907638
Physician Assistant - Medical in Los Angeles, CA

Active since March 27, 2013PECOS EnrolledAccepts Medicare Assignment
6368 HOLLYWOOD BLVD, LOS ANGELES, CA 90028(323) 469-5555(323) 466-0405 Get Directions Write a Review

NPPES record last updated: September 21, 2016. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Mr. Jon Charles Lacy Pa NPPES

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

MR. JON CHARLES LACY PA (NPI 1588907638) is an individual medical provider in Los Angeles, California, licensed in California (PA22770) and active in the NPI registry since March 2013. He is enrolled in Medicare PECOS and is a graduate of Other (2012).

NPPES Registry Identity

NPI1588907638
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameMR. JON CHARLES LACYCredential: PA
Location Address6368 HOLLYWOOD BLVDLos Angeles, CA 90028-6320
Mailing Address6368 Hollywood BlvdLos Angeles, CA 90028-6320 · (323) 469-5555 · Fax (323) 466-0405
Phone(323) 469-5555
Fax(323) 466-0405
Sole ProprietorNo
Medical School CMSOtherGraduated 2012
Enumeration DateMarch 27, 2013
Last NPPES UpdateSeptember 21, 2016
✔ NPI 1588907638 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in CA · PA22770
6368 HOLLYWOOD BLVD, Los Angeles, CA 90028
Open in Google Maps ↗

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

Mr. Jon Charles Lacy Pa 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 ID5597901058
PECOS Enrollment IDI20130429000527
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.

Referred Medical Equipment & Supplies CMS DME claims 4

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
13 suppliers31 claims90 services$5.44 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
10 suppliers19 claims23 services$0.98 avg. paid by Medicare
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) E0466
DME-Other DME · category DE005N
1 supplier12 claims12 services$773.23 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
1 supplier12 claims12 services$200.12 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 9

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

ST ANTHONY MEDICAL CENTERS
Clinic/Center (Federally Qualified Health Center (FQHC))
6368 HOLLYWOOD BLVD
HOLLYWOOD, CA 90028
Los Angeles County (323) 469-5555
SARA HENES
Physician Assistant
6368 HOLLYWOOD BLVD
LOS ANGELES, CA 90028
Los Angeles County (323) 469-5555
MONICA W MICHAEL PA-C
Physician Assistant
6368 HOLLYWOOD BLVD
LOS ANGELES, CA 90028
Los Angeles County (323) 469-5555
MISS LARISSA ISABEL PINEDA LVN
Licensed Vocational Nurse
6368 HOLLYWOOD BLVD
HOLLYWOOD, CA 90028
Los Angeles County (818) 522-7281
MS. AMANDA JEAN PARKER LCSW
Social Worker (Clinical)
6368 HOLLYWOOD BLVD
LOS ANGELES, CA 90028
Los Angeles County (323) 469-5555
MS. HAZEL BLUEN F.N.P.
Nurse Practitioner (Family)
6368 HOLLYWOOD BLVD
HOLLYWOOD, CA 90028
Los Angeles County (323) 469-5555
DR. AWAD ANTHONY M.D
Family Medicine
6368 HOLLYWOOD BLVD
HOLLYWOOD, CA 90028
Los Angeles County (323) 469-5555
ASTRAL PHARMACY INC
Pharmacy (Community/Retail Pharmacy)
6368 HOLLYWOOD BLVD
LOS ANGELES, CA 90028
Los Angeles County (323) 466-9931

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jon Lacy's NPI number?

The NPI number for Jon Lacy is 1588907638. It was assigned to this individual provider in the NPPES registry on March 27, 2013.

Where is Jon Lacy located?

Jon Lacy practices at 6368 Hollywood Blvd, Los Angeles, CA 90028. The listed phone number is (323) 469-5555.

What is Jon Lacy's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Jon Lacy enrolled in Medicare?

Yes. Jon Lacy is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Jon Lacy was last updated on September 21, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years 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.