NPIMap

Individual provider Active NPI

Lucas Fogarty

  • Physician Assistant
  • Berkeley, CA
National Provider Identifier
1033676622
Registry record updated Mar 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2222 Prince St
Berkeley, CA 94705-1819
Phone
(510) 982-9006
NPI assigned
Mar 1, 2019
Last updated
Mar 1, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

2222 Prince St
Berkeley, CA 94705-1819

Mailing address

2222 Prince St
Berkeley, CA 94705-1819
Phone (510) 982-9006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200420002551 CA Practitioner - Physician Assistant 2365872025 Reassigns benefits to 5 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of California San Francisco Medical Center Past Accepting new patients
Regents of the University of California Past Accepting new patients
University of California San Francisco Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: lfogarty169892@direct-ucsfmedicalcenter.org

Organizations & group practices 8

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

NPI Registry JSON

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

{
    "created_epoch": "1551398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551398400000",
    "number": "1033676622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 PRINCE ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947051819",
            "telephone_number": "510-982-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 PRINCE ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947051819",
            "telephone_number": "510-982-9006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOGARTY",
        "first_name": "LUCAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-01",
        "last_updated": "2019-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.