Lucas Raymond King

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

C185826 Issued in CA

Practice address

525 Doyle Park Dr Ste 101
Santa Rosa, CA 95405-4562

Phone

(707) 525-6620

Fax

(707) 522-1279

NPI assigned

Apr 7, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL, CA2 enrollments

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 2

Specialty

Orthopedic Surgery

Education

Loma Linda University School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Santa Rosa Memorial Hospital Hospital, Santa Rosa, CA, CCN 050174
• Petaluma Valley Hospital Hospital, Petaluma, CA, CCN 050136
• Healdsburg Hospital Hospital, Healdsburg, CA, CCN 051321
• Adventist Health Ukiah Valley Hospital, Ukiah, CA, CCN 050301

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lking2859664@oc.providencedirect.org

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.

• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment Care Compare group NPD (past)
• STV Sports Medicine & Orthopedics LLC

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Birmingham, AL
  • NPI 1467818575

  Orthopaedic Surgery

  Medicare reassignment NPD
• Providence Medical Foundation

  • General Practice Physician
  • Diamond Bar, CA
  • NPI 1285890624
  NPD
• Providence Medical Foundation

  • Surgery Physician
  • Eureka, CA
  • NPI 1477790517
  NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1639715709
  NPD
• STV Sports Medicine & Orthopedics LLC

  • Durable Medical Equipment & Medical Supplies
  • Pelham, AL
  • NPI 1770365504

  Orthopaedic Surgery

  NPD
• SRM Alliance Hospital Services

  • Skilled Nursing Facility
  • Petaluma, CA
  • NPI 1770703886
  NPD (past)
• St. Joseph Health Northern California, LLC

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1134152549
  NPD (past)

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

• Norcal Healthconnect LLC

  • General Acute Care Hospital
  • Petaluma, CA
  • NPI 1235162645
  Care Compare affiliation
• Norcal Healthconnect LLC

  • Multi-Specialty Clinic/Center
  • Healdsburg, CA
  • NPI 1720695547

  Hospital

  Care Compare affiliation
• Norcal Healthconnect LLC

  • Critical Access Hospital
  • Healdsburg, CA
  • NPI 1861009672
  Care Compare affiliation
• St. Joseph Health Northern California, LLC

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1134152549
  Care Compare affiliation
• Ukiah Adventist Hospital

  • General Acute Care Hospital
  • Ukiah, CA
  • NPI 1235120676
  Care Compare affiliation

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

{
    "created_epoch": "1302134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765238400000",
    "number": "1114216421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 DOYLE PARK DR STE 101",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054562",
            "telephone_number": "707-525-6620",
            "fax_number": "707-522-1279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 DOYLE PARK DR STE 101",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054562",
            "telephone_number": "707-525-6620",
            "fax_number": "707-522-1279"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3676 Parker Blvd.",
            "address_2": "Ste 310",
            "address_purpose": "LOCATION",
            "city": "Pueblo",
            "state": "CO",
            "postal_code": "810082215",
            "country_code": "US",
            "telephone_number": "719-595-7780",
            "fax_number": "719-595-7789",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1162 Montgomery Dr Ste 300",
            "address_purpose": "LOCATION",
            "city": "Santa Rosa",
            "state": "CA",
            "postal_code": "954054802",
            "country_code": "US",
            "telephone_number": "707-890-4250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KING",
        "first_name": "LUCAS",
        "middle_name": "RAYMOND",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-07",
        "last_updated": "2025-12-09",
        "certification_date": "2025-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CO",
            "license": "DR.0058676",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "C185826",
            "primary": true
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CO",
            "license": "DR.0058676",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AL",
            "license": "MD.35064",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000148102",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeanna Maye King-Ruppel, CWC
• Chung Liang King, L.AC.
• Courtney King, MD
• Jason Michael King, LVN
• Kathryn D King, LCSW
• Mariah King
• Nicholas King
• Phyllis King
• Rachel Elizabeth King, OTR/L, MS
• Victoria King

• Sports Medicine (Orthopaedic Surgery) Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.