Individual provider Active NPI

Lucas R Josephine, PA

  • Physician Assistant
  • North Kansas City, MO
National Provider Identifier
1194177543
Registry record updated Nov 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2016023821 Issued in MO
Practice address
2800 Clay Edwards Drive
North Kansas City, MO 64116-4673
Phone
(816) 691-2000
Fax
(816) 346-7242
NPI assigned
Jul 11, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085006274 IL
Physician Assistant 363A00000X 2016023821 MO Primary

Addresses

Primary practice location

2800 Clay Edwards Drive
North Kansas City, MO 64116-4673

Mailing address

PO Box 11157
Kansas City, MO 64119-0157
Phone (855) 381-3941

Other practice location 1

1000 Carondelet Dr
Kansas City, MO 64114-4673
Phone (816) 942-4400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160727000330 MO Practitioner - Physician Assistant 8628361789 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

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": "1468195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543276800000",
    "number": "1194177543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11157",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641190157",
            "telephone_number": "855-381-3941",
            "fax_number": "855-291-1862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 CLAY EDWARDS DRIVE",
            "city": "NORTH KANSAS CITY",
            "state": "MO",
            "postal_code": "641164673",
            "telephone_number": "816-691-2000",
            "fax_number": "816-346-7242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Carondelet Dr",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641144673",
            "country_code": "US",
            "telephone_number": "816-942-4400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOSEPHINE",
        "first_name": "LUCAS",
        "middle_name": "R",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-11",
        "last_updated": "2018-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085006274",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2016023821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Kansas City, MO

Sources for this page

Verify at the official NPI Registry.