Jared Lutsic, DO

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

5151017542APP25 Issued in MI

Practice address

12000 E 12 Mile Rd
Warren, MI 48093-3570

Phone

(586) 759-7300

NPI assigned

Apr 21, 2025

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

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1745193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745193600000",
    "number": "1114714680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12000 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933570",
            "telephone_number": "586-759-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933570",
            "telephone_number": "586-759-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUTSIC",
        "first_name": "JARED",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-21",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "5151017542APP25",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chantille Luckett
• Luis E Bustos M.D.,P.C.
• Luna Home Care Services LLC
• Alexander R Lussier, MD
• Jennifer Lynn Lutostanski, LBSW
• Luxottica Retail North America Inc
• M M E and Supplies Inc
• M Run LLC
• M.D. Optical, Warren LTD.
• Jae Joon Ma, DDS

• Orthopaedic Surgery Physician in Warren, MI
• Providers in Warren, MI by specialty
• Orthopaedic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.