Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Jon Charles Lacy, PA

Individual provider Medical Physician Assistant · NPI 1588907638

Mr. Jon Charles Lacy, PA is a Physician Assistant in Los Angeles, California. Qualified in 2012, 14 years ago. Practices with Portola Medical Services PC, a 23-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
14
Licensed in
CA
In the registry since
2013
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

6368 Hollywood Blvd
Los Angeles, CA 90028-6320
Phone: (323) 469-5555
Fax: (323) 466-0405
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA22770 (CA)

Record details

NPI number1588907638
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedMarch 27, 2013
Last updated in NPPESSeptember 21, 2016

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Portola Medical Services Pc — 23 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations7 on file with Medicare

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