NPIMap

Individual provider Active NPI

Luckricia Olivacce, PA

  • Medical Physician Assistant
  • Hagerstown, MD
National Provider Identifier
1053788422
Registry record updated Mar 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
C0005876 Issued in MD
Practice address
1150 Professional CT
Suite P
Hagerstown, MD 21740-4100
Phone
(301) 665-9696
Fax
(240) 420-5715
NPI assigned
Sep 1, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X C0005876 MD Primary

Addresses

Primary practice location

1150 Professional CT
Suite P
Hagerstown, MD 21740-4100

Mailing address

11350 McCormick Rd
Executive Plaza 1, Suite 501
Hunt Valley, MD 21031-1002
Phone (301) 669-9696

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address LOlivacce@treatingpain.emadirect.md

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20151123002414 MD Practitioner - Physician Assistant 5698075679 Reassigns benefits to 1 organization
I20240909001744 NC Practitioner - Physician Assistant 5698075679 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4515 Premier Dr
High Point, NC 27265-8356

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
98
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
99.15 of 100Reported as group
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Pain Management, LLC CurrentSince Aug 17, 2015 Accepting new patients
Wake Forest University Health Sciences CurrentSince Jul 1, 2024 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

510 Upper Chesapeake Dr
Ste 415
Bel Air, MD 21014
Phone (443) 643-3000

16900 Science Dr
Ste 100
Bowie, MD 20715
Phone (301) 464-7008

7120 Minstrel Way
Ste 106
Columbia, MD 21045
Phone (410) 290-9191

19735 Germantown Rd
Ste 360
Germantown, MD 20874
Phone (301) 528-2810

1600 Crain Hwy S
Ste 301A
Glen Burnie, MD 21061

1600 Crain Hwy S
Ste 301
Glen Burnie, MD 21061
Phone (410) 760-1400

1150 Professional Ct
Ste P
Hagerstown, MD 21740
Phone (301) 665-9696

1150 Professional Ct
Ste B
Hagerstown, MD 21740
Phone (301) 797-4901

11350 McCormick Rd
Ste 501
Hunt Valley, MD 21031
Phone (410) 329-1071

1838 Greene Tree Rd
Ste 150
Pikesville, MD 21208
Phone (301) 881-7246

6820 Hospital Dr
Ste 302
Rosedale, MD 21237
Phone (410) 682-2823

8455 Colesville Rd
Ste 200
Silver Spring, MD 20910
Phone (301) 528-2810

3460 Old Washington Rd
Ste 300
Waldorf, MD 20602
Phone (301) 645-1523

4515 Premier Dr
High Point, NC 27265
Phone (336) 716-4216

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Interoperability endpoints

  • Direct secure messaging: lolivacce@treatingpain.emadirect.md

Organizations & group practices 3

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.

Hospital & facility affiliations 6

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": "1441065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1053788422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11350 MCCORMICK RD",
            "address_2": "EXECUTIVE PLAZA 1, SUITE 501",
            "city": "HUNT VALLEY",
            "state": "MD",
            "postal_code": "210311002",
            "telephone_number": "301-669-9696",
            "fax_number": "240-420-5715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 PROFESSIONAL CT",
            "address_2": "SUITE P",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217404100",
            "telephone_number": "301-665-9696",
            "fax_number": "240-420-5715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVACCE",
        "first_name": "LUCKRICIA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-01",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0005876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "LOlivacce@treatingpain.emadirect.md",
            "affiliation": "N",
            "address_1": "1150 Professional Ct",
            "address_2": "Suite P",
            "city": "Hagerstown",
            "state": "MD",
            "country_code": "US",
            "postal_code": "217404100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

Verify at the official NPI Registry.