Luke Gibson Renner

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

OT020721 Issued in PA

Practice address

700 Hawk Ridge Dr
Hamburg, PA 19526-9219

Phone

(610) 562-3066

Fax

(610) 562-3125

NPI assigned

May 21, 2021

Last updated

May 21, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1093380131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2787 BRIDLE PATH ST",
            "city": "SLATINGTON",
            "state": "PA",
            "postal_code": "180804033",
            "telephone_number": "484-226-5815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 HAWK RIDGE DR",
            "city": "HAMBURG",
            "state": "PA",
            "postal_code": "195269219",
            "telephone_number": "610-562-3066",
            "fax_number": "610-562-3125"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 N 17th St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Allentown",
            "state": "PA",
            "postal_code": "181045052",
            "country_code": "US",
            "telephone_number": "610-969-3500",
            "fax_number": "610-969-3605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RENNER",
        "first_name": "LUKE",
        "middle_name": "GIBSON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-21",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PA",
            "license": "OT020721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Hamburg, PA
• Providers in Hamburg, PA by specialty
• General Practice Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; 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.