JACOB GRAY LACKEY PA-C
NPI 1699178731
Physician Assistant in Clemmons, NC

Q: What is Jacob Lackey's NPI number?

The NPI number for Jacob Lackey is 1699178731. It was assigned to this individual provider in the NPPES registry on October 3, 2014.

Q: What is Jacob Lackey's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Jacob Lackey was last updated on August 18, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.

Active since October 03, 2014PECOS EnrolledAccepts Medicare Assignment

3163 GAMMON LN, CLEMMONS, NC 27012(336) 310-5571(336) 310-5574 Get Directions Write a Review

NPPES record last updated: August 18, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 18, 2021, Jun 14, 2021, Nov 19, 2020 and 1 more (4 updates tracked since 2017).

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About Jacob Gray Lackey Pa-c NPPES

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

JACOB GRAY LACKEY PA-C (NPI 1699178731) is an individual physician assistant in Clemmons, North Carolina, licensed in North Carolina (0010-05288) and active in the NPI registry since October 2014. He is enrolled in Medicare PECOS, is affiliated with Watauga Medical Center, and is a graduate of Other (2014).

NPPES Registry Identity

NPI1699178731

Entity TypeIndividualMale

Primary Taxonomy363A00000X

Provider Legal NameJACOB GRAY LACKEYCredential: PA-C

Location Address3163 GAMMON LNClemmons, NC 27012-9052

Mailing AddressPo Box 601843Charlotte, NC 28260-1843

Phone(336) 310-5571

Fax(336) 310-5574

Sole ProprietorNo

Medical School CMSOtherGraduated 2014

Enumeration DateOctober 3, 2014

Last NPPES UpdateAugust 18, 20214 updates tracked since enumeration

NPPES CertifiedAugust 18, 2021

✔ NPI 1699178731 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in NC · 0010-05288

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Also ListedPhysician Assistant · MedicalTaxonomy 363AM0700X · License 001005288 (NC)

3163 GAMMON LN, Clemmons, NC 27012

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC, UnitedHealthcare.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

Jacob Gray Lackey Pa-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 ID6204150469

PECOS Enrollment IDI20150115002445

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 18

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.

Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg J3304

Triamcinolone acetonide is a long-lasting, preservative-free steroid injection. It's delivered in tiny, slow-releasing particles (microspheres) to manage inflammation or related conditions. The dose given is 1 mg. It's generally safe with few side effects.

1,312 services28 patients

Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg J7325

Synvisc or Synvisc-One is a treatment involving an injection of a substance called hyaluronan into your joints. This substance, naturally found in the body, helps lubricate and cushion your joints, reducing pain and improving mobility. It's often used for arthritis patients.

896 services13 patients

Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg J0702

This injection contains two medications, betamethasone acetate and betamethasone sodium phosphate. It is used to reduce inflammation and pain. It's given by a healthcare professional, often directly into the area causing discomfort.

370 services144 patients

Aspiration and/or injection of fluid from large joint 20610

This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.

280 services178 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

270 services203 patients

X-ray of knee, 4 or more views 73564

An X-ray of the knee, 4 or more views, is a non-invasive imaging test. It involves capturing multiple images of your knee from different angles. This helps in diagnosing conditions such as fractures, arthritis, or infections. The procedure is quick and painless.

186 services144 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

141 services123 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

97 services97 patients

X-ray of hip, 2-3 views 73502

An X-ray of the hip with 2-3 views is a non-invasive imaging test. It uses a small amount of radiation to produce pictures of the hip joint. These images help in diagnosing conditions like fractures, arthritis, or other abnormalities. The process is quick and painless.

85 services81 patients

Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose J7323

Hyaluronan or Euflexxa is a substance similar to a natural substance in your joints. It's injected into the joint space to treat pain from osteoarthritis, especially in the knee. It helps to lubricate the joint, reducing pain and improving mobility.

85 services24 patients

X-ray of shoulder, minimum of 2 views 73030

An X-ray of the shoulder, with a minimum of 2 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of your shoulder bones. This helps in diagnosing conditions like fractures, arthritis, or other abnormalities. The procedure is quick and painless.

64 services56 patients

X-ray of knee, 3 views 73562

An X-ray of the knee, 3 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of the knee from three different angles. This helps medical professionals to diagnose and monitor conditions like arthritis, fractures, or infections. The process is quick and painless.

30 services26 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

29 services29 patients

Injection, methylprednisolone acetate, 40 mg J1030

Methylprednisolone acetate is a medication given through an injection. It's a type of corticosteroid, which reduces inflammation and immune responses. It can be used to treat various conditions like arthritis, allergies, and skin diseases. This dose is 40 mg.

26 services22 patients

X-ray of both hips, 3-4 views 73522

An X-ray of both hips with 3-4 views is a safe imaging procedure. It involves capturing multiple pictures of your hip joints from different angles. This helps in diagnosing conditions like arthritis or fractures. You'll need to stay still during the process for clear images.

22 services22 patients

X-ray of ankle, minimum of 3 views 73610

An ankle X-ray is a quick, painless imaging test. It involves capturing at least three different images or 'views' of your ankle using small amounts of radiation. These images help identify any abnormalities or injuries, such as fractures or arthritis.

22 services14 patients

X-ray of lower and sacral spine, 2-3 views 72100

An X-ray of the lower and sacral spine involves capturing images of your lower back area, including the tailbone. This procedure helps in identifying problems like fractures, infections, or deformities. 2-3 different angle views provide a comprehensive picture.

17 services17 patients

X-ray of wrist, minimum of 3 views 73110

An X-ray of the wrist, minimum of 3 views, is a diagnostic procedure that uses radiation to create images of your wrist from different angles. This helps detect fractures, infections, or other abnormalities for accurate diagnosis and treatment planning.

16 services13 patients

Hospital Affiliations CMS Care Compare 5

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

Watauga Medical Center

Acute Care Hospitals · Boone, NC

3/5 CMS rating

OwnershipGovernment - Local

CMS Certification Number340051

Location336 Deerfield RoadBoone, NC 28607 · Watauga County

Emergency services Birthing friendly

Frye Regional Medical Center

Acute Care Hospitals · Hickory, NC

1/5 CMS rating

OwnershipProprietary

CMS Certification Number340116

Location420 N Center StHickory, NC 28601 · Catawba County

Emergency services Birthing friendly

Charles A Cannon Jr Memorial Hospital

Critical Access Hospitals · Linville, NC

OwnershipVoluntary non-profit - Private

CMS Certification Number341323

Location434 Hospital DriveLinville, NC 28646 · Avery County

Emergency services

Ashe Memorial Hospital

Critical Access Hospitals · Jefferson, NC

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number341325

Location200 Hospital AveJefferson, NC 28640 · Ashe County

Emergency services

Johnson County Community Hospital

Critical Access Hospitals · Mountain City, TN

OwnershipVoluntary non-profit - Private

CMS Certification Number441304

Location1901 S Shady StMountain City, TN 37683 · Johnson County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 27012 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$83.90 typical visit price

range $54.12 – $165.09

Typical copayment $20.97 (range $13.53 – $41.27)

Most-billed visit code 99203

Established Patient

$67.72 typical visit price

range $17.21 – $134.61

Typical copayment $16.93 (range $4.30 – $33.65)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

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

DR. JOSHUA FLEMING DNP-FNP

Nurse Practitioner

3163 GAMMON LN
CLEMMONS, NC 27012

Forsyth County (336) 310-5571

MRS. ANDREA DAWN STOKES UNDERWOOD DNP, FNP-C

Nurse Practitioner

3163 GAMMON LN
CLEMMONS, NC 27012

Forsyth County (336) 310-5571

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 Jacob Lackey's NPI number?

The NPI number for Jacob Lackey is 1699178731. It was assigned to this individual provider in the NPPES registry on October 3, 2014.

Where is Jacob Lackey located?

Jacob Lackey practices at 3163 Gammon Ln, Clemmons, NC 27012. The listed phone number is (336) 310-5571.

What is Jacob Lackey's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Jacob Lackey enrolled in Medicare?

Yes. Jacob Lackey 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.

What insurance does Jacob Lackey accept?

Health plans from Blue Cross and Blue Shield of NC and UnitedHealthcare list Jacob Lackey as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Jacob Lackey affiliated with any hospitals?

According to CMS data, Jacob Lackey is affiliated with Watauga Medical Center, Frye Regional Medical Center, Charles A Cannon Jr Memorial Hospital, Ashe Memorial Hospital and Johnson County Community Hospital.

When was this NPI record last updated?

The NPPES record for Jacob Lackey was last updated on August 18, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.