Active NPI
Lincoln Daniel Lutrick
- Family Medicine Physician
- Des Moines, IA
National Provider Identifier
1174372874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R-13108
- Practice address
- 1801 Hickman Rd
Des Moines, IA 50314-1597 - Phone
- (515) 282-2200
- NPI assigned
- May 15, 2024
- Last updated
- May 15, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R-13108 | IA | Primary |
Addresses
Primary practice location
1801 Hickman Rd
Des Moines, IA 50314-1597
Mailing address
201 Shellway Dr
Mount Ayr, IA 50854-1233
Phone (641) 464-3593
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240829001868 | IA | Order and Referring Only - Family Practice | 3678012077 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715731200000",
"number": "1174372874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 SHELLWAY DR",
"city": "MOUNT AYR",
"state": "IA",
"postal_code": "508541233",
"telephone_number": "641-464-3593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 HICKMAN RD",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503141597",
"telephone_number": "515-282-2200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUTRICK",
"first_name": "LINCOLN",
"middle_name": "DANIEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-15",
"last_updated": "2024-05-15",
"certification_date": "2024-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "R-13108",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Des Moines, IA
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; 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.