NPIMap

Organization Active NPI

Integrated Wound Care Kentucky PLLC

  • Primary Care Nurse Practitioner
  • Phelps, KY
National Provider Identifier
1144970641
Registry record updated Dec 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
INTEGRATED WOUND CARE KENTUCKY PLLC
Practice address
60 Phillips Branch Rd
Phelps, KY 41553-9061
Phone
(718) 963-3495
NPI assigned
Mar 27, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2022

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

Authorized official

Name
Dr. Diane Lusas, MDNPI 1730475658
Title
Member
Phone
(718) 963-3495

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Primary Care Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP2300X Primary

Addresses

Primary practice location

60 Phillips Branch Rd
Phelps, KY 41553-9061

Mailing address

492C Cedar LN Ste 514
Teaneck, NJ 07666-1713

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220511001383 KY Part B Supplier - Clinic/Group Practice 7416334537 Receives reassigned benefits from 7 practitioners
Practice locations: Phelps, KY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1648339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672272000000",
    "number": "1144970641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "492C CEDAR LN STE 514",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076661713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 PHILLIPS BRANCH RD",
            "city": "PHELPS",
            "state": "KY",
            "postal_code": "415539061",
            "telephone_number": "718-963-3495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED WOUND CARE KENTUCKY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-27",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A",
        "authorized_official_last_name": "LUSAS",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "718-963-3495",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phelps, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.