NPIMap

Individual provider Active NPI

Lucas Kyle Buckley, MD

  • Diagnostic Radiology Physician
  • Belleville, IL
National Provider Identifier
1194040634
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036145163 Issued in IL
Practice address
4500 Memorial Dr
Dept Radiology
Belleville, IL 62226-5360
Phone
(618) 257-5613
Fax
(314) 454-4641
NPI assigned
Mar 27, 2010
Last updated
Oct 21, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 036145163 IL Primary

Addresses

Primary practice location

4500 Memorial Dr
Dept Radiology
Belleville, IL 62226-5360

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (618) 257-5613

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180420002432 IL Practitioner - Diagnostic Radiology 6901127257 Reassigns benefits to 2 organizations
I20190903000116 MO Practitioner - Diagnostic Radiology 6901127257 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clinical Radiologists SCGroup PAC ID 3476540873, 32 clinicians

Practice addresses (Care Compare)

100 Medical Dr
Hannibal, MO 63401-6877
Phone (573) 221-5250

3050 Montvale Dr
Suite a
Springfield, IL 62704-6924
Phone (217) 726-8096

4500 Memorial Dr
Belleville, IL 62226-5360
Phone (314) 747-1171

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Miracl, LLC CurrentSince Oct 22, 2025 Accepting new patients
Washington University Physicians in Illinois, Inc CurrentSince Jan 19, 2026 Accepting new patients
Crawford Hospital District Current Accepting new patients
Washington University Physicians in Illinois, Inc CurrentSince Jan 19, 2026 Accepting new patients
Washington University Diagnostic Radiology CurrentSince Oct 22, 2025 Accepting new patients
Schuyler County Hospital District Past Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

4500 Memorial Dr
Belleville, IL 62226
Phone (618) 233-7750

2122 Troy Rd
Ste 130
Edwardsville, IL 62025
Phone (618) 692-9876

1000 N Allen St
Robinson, IL 62454
Phone (618) 544-3131

100 Medical Dr
Hannibal, MO 63401

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

510 S Kingshighway Blvd
Saint Louis, MO 63110
Phone (314) 362-0177

Organizations & group practices 8

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1269648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761004800000",
    "number": "1194040634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "618-257-5613",
            "fax_number": "314-454-4641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 MEMORIAL DR",
            "address_2": "DEPT RADIOLOGY",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265360",
            "telephone_number": "618-257-5613",
            "fax_number": "314-454-4641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "LUCAS",
        "middle_name": "KYLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-27",
        "last_updated": "2025-10-21",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036145163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4500 Memorial Dr",
            "address_2": "Dept Radiology",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622265360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

Verify at the official NPI Registry.