NPIMap

Individual provider Active NPI

Reeju Ellookunnel Lukose, PA

  • Surgical Physician Assistant
  • Houston, TX
National Provider Identifier
1043512858
Registry record updated Aug 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA09978 Issued in TX
Practice address
6550 Fannin St
Suite 2600
Houston, TX 77030-2717
Phone
(713) 790-1818
Fax
(713) 790-7500
NPI assigned
Nov 30, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 014197 NY
Surgical Physician Assistant 363AS0400X PA09978 TX Primary

Addresses

Primary practice location

6550 Fannin St
Suite 2600
Houston, TX 77030-2717

Mailing address

6550 Fannin St
Suite 2600
Houston, TX 77030-2717
Phone (713) 790-1818

Other identifiers 2

IdentifierTypeStateIssuer
8800NVOtherTXBLUE CROSS BLUE SHIELD
356622602MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20160419000720 TX Practitioner - Physician Assistant 0345422440 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ut PhysiciansGroup PAC ID 8426960360, 1,744 clinicians

Practice addresses (Care Compare)

5420 W Loop S
Suite 2400
Bellaire, TX 77401-2107
Phone (713) 486-3550

6410 Fannin St
Houston, TX 77030-3005

6411 Fannin St
Houston, TX 77030-1501
Phone (713) 704-0093

6414 Fannin St
Suite G125
Houston, TX 77030-1517

6431 Fannin St
MSB2.100
Houston, TX 77030-1501
Phone (713) 500-7700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA09978TXMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Physicians CurrentSince Jul 1, 2016 Accepting new patients
TMH Physician Associates PLLC CurrentSince Jul 19, 2016 Accepting new patients
TMH Physician Associates PLLC CurrentSince Jul 19, 2016 Accepting new patients
Ut Physicians CurrentSince Jul 1, 2016 Accepting new patients

Locations

7575 San Felipe St
Ste 155
Houston, TX 77063
Phone (713) 266-9955

6550 Fannin St
#M1076
Houston, TX 77030
Phone (713) 441-2670

6550 Fannin St
Ste 2600
Houston, TX 77030
Phone (713) 441-2663

6410 Fannin St
Ste 500
Houston, TX 77030
Phone (713) 500-5714

6414 Fannin St
Ste G150
Houston, TX 77030
Phone (713) 486-7560

Interoperability endpoints

  • Direct secure messaging: rlukose14175@direct.uth.org

Organizations & group practices 4

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1291075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472515200000",
    "number": "1043512858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6550 FANNIN ST",
            "address_2": "SUITE 2600",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302717",
            "telephone_number": "713-790-1818",
            "fax_number": "713-790-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6550 FANNIN ST",
            "address_2": "SUITE 2600",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302717",
            "telephone_number": "713-790-1818",
            "fax_number": "713-790-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUKOSE",
        "first_name": "REEJU",
        "middle_name": "ELLOOKUNNEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-30",
        "last_updated": "2016-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "014197",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA09978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8800NV",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "356622602",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.