Individual provider Active NPI

Lucas C McCully, DC

  • Chiropractor
  • Crystal Lake, IL
National Provider Identifier
1154567659
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH60043071 Issued in WA
Practice address
820 E Terra Cotta Ave Ste 144
Crystal Lake, IL 60014-3634
Phone
(815) 526-3658
NPI assigned
Jan 5, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH60043071 WA Primary

Addresses

Primary practice location

820 E Terra Cotta Ave Ste 144
Crystal Lake, IL 60014-3634

Mailing address

820 E Terra Cotta Ave Ste 144
Crystal Lake, IL 60014-3634
Phone (815) 526-3658

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230927000241 IL Practitioner - Chiropractic 9335363084 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College - West, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

820 E Terra Cotta Ave
Suite 144
Crystal Lake, IL 60014-3634
Phone (815) 526-3658

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
CH60043071WAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
McCully Atlas Spinal Care Chiropractic, P.C. Chiropractor CurrentSince Aug 13, 2023 Accepting new patients

Locations

4655 Hoen Ave
Ste 8
Santa Rosa, CA 95405
Phone (707) 545-8881

820 E Terra Cotta Ave
Ste 144
Crystal Lake, IL 60014
Phone (815) 526-3658

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1231113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1154567659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 E TERRA COTTA AVE STE 144",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143634",
            "telephone_number": "815-526-3658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E TERRA COTTA AVE STE 144",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143634",
            "telephone_number": "815-526-3658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLY",
        "first_name": "LUCAS",
        "middle_name": "C",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-05",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH60043071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.