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ROY JARETH LACKEY PA-C
NPI 1962169011
Physician Assistant in San Diego, CA

Active since November 23, 2021PECOS Enrolled
34800 BOB WILSON DR, SAN DIEGO, CA 92134(619) 532-6400 Get Directions Write a Review

NPPES record last updated: February 22, 2023. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Feb 22, 2023, Nov 23, 2021 (2 updates tracked since 2021).

About Roy Jareth Lackey Pa-c NPPES

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

ROY JARETH LACKEY PA-C (NPI 1962169011) is an individual physician assistant in San Diego, California and active in the NPI registry since November 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1962169011
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameROY JARETH LACKEYCredential: PA-C
Location Address34800 BOB WILSON DRSan Diego, CA 92134-1098
Mailing Address32863 Abana CtTemecula, CA 92592-9271 · (843) 597-5477
Phone(619) 532-6400
Sole ProprietorNo
Enumeration DateNovember 23, 2021
Last NPPES UpdateFebruary 22, 20232 updates tracked since enumeration
NPPES CertifiedFebruary 22, 2023
✔ NPI 1962169011 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
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 ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
34800 BOB WILSON DR, San Diego, CA 92134
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Roy Jareth Lackey Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92134 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
$94.87 typical visit price
range $62.10 – $184.71
Typical copayment $23.71 (range $15.52 – $46.17)
Most-billed visit code 99203
Established Patient
$76.87 typical visit price
range $20.62 – $151.42
Typical copayment $19.21 (range $5.15 – $37.85)
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 20

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

LORENA MARIE FUJII N.P.
Nurse Practitioner (Pediatrics)
34800 BOB WILSON DR
SAN DIEGO, CA 92134
San Diego County (619) 532-8910
LAKIESHA NICOLE MURPHY
Nurse's Aide
34800 BOB WILSON DR
SAN DIEGO, CA 92134
San Diego County (619) 713-3385
SUSANNA BYRNE D.O.
Anesthesiology
34800 BOB WILSON DR
SAN DIEGO, CA 92134
San Diego County (619) 532-6400
DR. PAUL CHARLES CAMPBELL D.O.
Urology (Pediatric Urology)
34800 BOB WILSON DR
SAN DIEGO, CA 92134
San Diego County (619) 532-7200
PHILLIP EDWARD FRY JR. DO
Emergency Medicine
34800 BOB WILSON DR
SAN DIEGO, CA 92134
San Diego County (619) 532-6400
BRADLY JAMES STILLEY IDC
Military Health Care Provider (Independent Duty Corpsman)
34800 BOB WILSON DR
SAN DIEGO, CA 92134
San Diego County (360) 941-9989
DR. ELIZABETH WHIPPLE PHD
Military Health Care Provider
34800 BOB WILSON DR
SAN DIEGO, CA 92134
San Diego County (619) 532-6400
DR. ELAN HARDER BRESSLOUR-RASHAP MD
General Practice
34800 BOB WILSON DR
SAN DIEGO, CA 92134
San Diego County (619) 532-6400

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 Roy Lackey's NPI number?

The NPI number for Roy Lackey is 1962169011. It was assigned to this individual provider in the NPPES registry on November 23, 2021.

Where is Roy Lackey located?

Roy Lackey practices at 34800 Bob Wilson Dr, San Diego, CA 92134. The listed phone number is (619) 532-6400.

What is Roy Lackey's specialty?

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

Is Roy Lackey enrolled in Medicare?

Yes. Roy Lackey is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Roy Lackey was last updated on February 22, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.