Carlos Estanislao Lucero, MD

Primary specialty

Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X

License

10355 Issued in WV

Practice address

403 Carriage Drive
Beckley, WV 25801

Phone

(304) 255-7456

Fax

(304) 255-5899

NPI assigned

May 23, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Beckley Neonatal Pediatric Care Professional name

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Scotland Memorial Hospital Inc

  dba SURGICAL ASSOCIATES of SCOTLAND

  • Vascular Surgery Physician
  • Laurinburg, NC
  • NPI 1477791507
  Medicare reassignment NPD
• Kelly Medical Services Corporation LLC

  dba Kelly Medical Corporation

  • Emergency Medicine Physician
  • Welch, WV
  • NPI 1033154810
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215388800000",
    "number": "1033164645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 CARRIAGE DR",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258012805",
            "telephone_number": "304-255-7456",
            "fax_number": "304-255-5899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 CARRIAGE DRIVE",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "25801",
            "telephone_number": "304-255-7456",
            "fax_number": "304-255-5899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCERO",
        "first_name": "CARLOS",
        "middle_name": "ESTANISLAO",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2008-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "WV",
            "license": "10355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0112021000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BECKLEY",
            "last_name": "PEDIATRIC CARE",
            "middle_name": "NEONATAL",
            "credential": "DBA NAME",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• David W Lucas
• Elizabeth Lucas
• John M Lucas, CRNA
• Sarah Lucas, PHARD
• Shannon N Lucas
• Tristan Grant Lucky
• Ernest P Luczkowski, DPM
• Lumina Kidney Care Inc
• Breandon Lusk
• Jeanne Trishia Manzana Luzarraga, PT

• Developmental - Behavioral Pediatrics Physician in Beckley, WV
• Providers in Beckley, WV by specialty
• Developmental - Behavioral Pediatrics Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.