Individual provider Active NPI

Lucas Knewstub

  • Emergency Medicine Physician
  • Ithaca, NY
National Provider Identifier
1083103642
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
308462 Issued in NY
Practice address
101 Dates Dr
Ithaca, NY 14850-1383
Phone
(607) 274-4011
NPI assigned
May 8, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 308462 NY Primary

Addresses

Primary practice location

101 Dates Dr
Ithaca, NY 14850-1383

Mailing address

101 Dates Dr
Ithaca, NY 14850-1342

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20210713000162 NY Practitioner - Emergency Medicine 6204238306 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
New York College of Osteo Medicine of New York Institute of Technology, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cma Medical Practice PLLC 28 clinicians
Schuyler Hospital Inc 41 clinicians

Practice addresses (Care Compare)

101 Dates Dr
Ithaca, NY 14850-1342
Phone (607) 274-4411

220 Steuben St
Montour Falls, NY 14865-9740
Phone 607535863952353

Hospital & facility affiliations

  • Cayuga Medical Center at Ithaca Hospital, Ithaca, NY, CCN 330307
  • Schuyler Hospital Hospital, Montour Falls, NY, CCN 331313

Merit-based Incentive Payment System (MIPS)

Final score
94.27 of 100Reported as apm
Quality
82.87
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Cayuga Medical Associates, PC CurrentSince Aug 1, 2021 Accepting new patients
Schuyler Hospital Inc CurrentSince Aug 15, 2023 Accepting new patients
Cma Medical Practice PLLC Emergency Medicine CurrentSince Jul 15, 2021 Accepting new patients
Schuyler Hospital Inc CurrentSince Jan 14, 2026 Accepting new patients
Schuyler Hospital Inc CurrentSince Aug 15, 2023 Accepting new patients

Locations

1129 Commons Ave
#C
Cortland, NY 13045
Phone (607) 339-0456

8 Brentwood Dr
Ste B
Ithaca, NY 14850
Phone (607) 266-7500

310 Taughannock Blvd
Fl 4
Ithaca, NY 14850
Phone (607) 269-0100

101 Harris B Dates Dr
Ithaca, NY 14850
Phone (607) 274-4011

220 Steuben St
Montour Falls, NY 14865
Phone (607) 535-7121

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1525737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1083103642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 DATES DR",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 DATES DR",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501383",
            "telephone_number": "607-274-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNEWSTUB",
        "first_name": "LUCAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-08",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "308462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ithaca, NY

Sources for this page

Verify at the official NPI Registry.