Todd Jefferson Lucas, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

39634 Issued in TN

Practice address

1265 E College St
Suite 9
Pulaski, TN 38478-4541

Phone

(931) 424-9069

Fax

(931) 424-9079

NPI assigned

Jul 20, 2005

Last updated

Jul 29, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southeast Surgical, PLLC

  • Surgery Physician
  • Pulaski, TN
  • NPI 1275591851
  NPD (past) Authorized official

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217289600000",
    "number": "1184623258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1265 E COLLEGE ST",
            "address_2": "SUITE 9",
            "city": "PULASKI",
            "state": "TN",
            "postal_code": "384784541",
            "telephone_number": "931-424-9069",
            "fax_number": "931-424-9079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 E COLLEGE ST",
            "address_2": "SUITE 9",
            "city": "PULASKI",
            "state": "TN",
            "postal_code": "384784541",
            "telephone_number": "931-424-9069",
            "fax_number": "931-424-9079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCAS",
        "first_name": "TODD",
        "middle_name": "JEFFERSON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2008-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "39634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3332157",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa a Weaver (Eastside Family Medical Clinic)
• Constance Sabrina Long, P.A.
• David R Long, PHYSICAL THERAPIST
• Longs Physical Therapy Clinic
• Bethany Diane Lowry, DPT
• Joshua James Lunn, DPT
• Eva Perez Maboloc
• Purushothaman Madhu, MD
• Magnolia Ranch Recovery LLC
• Magnolias Way LLC

• Surgery Physician in Pulaski, TN
• Providers in Pulaski, TN by specialty
• Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2008; 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.