KEVIN LACK (P.A.-C) – Surgical Physician Assistant, NPI 1417924028
Surgical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,430 PHYSICIAN ASSISTANT in GA
Provider Addresses for KEVIN LACK (P.A.-C)
3651 Wheeler Rd
Augusta, GA 309096521
Phone: (706) 863-9595
Type: Location
Augusta Post Office, 40, Western Avenue, Augusta, Kennebec County, Maine, 04330, United States
AUGUSTA, GA 309143726
Phone: (706) 863-9595
Fax: (888) 745-3917
Type: Mailing
3675, J Dewey Gray Circle, Augusta, Richmond County, Georgia, 30909, United States
SUITE 300
AUGUSTA, GA 309091868
Phone: (706) 863-9595
Fax: (888) 745-3917
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $234.
Total Amount is formed as General ($234) + Research ($0) + Ownership ($0) = $234.
Last reported payment date: 2023-11-29 • Largest payer in this snapshot: Avita Medical Americas, LLC ($234).
Total Amount
$234
General + Research + Ownership
Payments
2
Total payment records
General Amount
$234
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-11-29
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Avita Medical Americas, LLC | $234 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2007-11-26
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20041004000710 | I | Physician Assistant | GA | TBD |
| I20071126000104 | I | Physician Assistant | SC | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 15003 | 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 | 239 | 20 | $0 |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 43 | 21 | $0 |
| 15002 | Preparation of skin graft site of trunk, arms, or legs, 100.0 sq cm or 1% body area for infants and children, or less | 31 | 27 | $0 |
Insurance plans in this area (ZIP 30909)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | GA | |
| - | GA | |
| Plastic And Reconstructive Surgery | MS | |
| Physician Assistant | GA | |
| Plastic And Reconstructive Surgery | GA | |
| - | GA | |
| Plastic And Reconstructive Surgery | GA | |
| - | WI | |
| Plastic And Reconstructive Surgery, Critical Care (Intensivists), General Surgery | GA | |
| Nurse Practitioner | GA |
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