Individual provider Active NPI

Edna Lucio, OT

  • Occupational Therapist
  • Lake Jackson, TX
National Provider Identifier
1245216654
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Practice address
337 Sheri LN
Lake Jackson, TX 77566-3269
Phone
(281) 229-0263
Fax
(800) 419-5153
NPI assigned
Dec 16, 2005
Last updated
Jun 23, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X
Occupational Therapist 225X00000X Primary

Addresses

Primary practice location

337 Sheri LN
Lake Jackson, TX 77566-3269

Mailing address

337 Sheri LN
Lake Jackson, TX 77566-3269
Phone (281) 229-0263

Other identifiers 1

IdentifierTypeStateIssuer
3264970MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060426000289 TX Practitioner - Occupational Therapist in Private Practice 8224048962 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Angel Leaf Rehab and Consulting LLCGroup PAC ID 2668636192, 4 clinicians

Practice addresses (Care Compare)

309 Plantation Dr
Lake Jackson, TX 77566-6142
Phone (979) 418-7165

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Angel Leaf Rehab and Consulting LLC Occupational Therapist CurrentSince Mar 21, 2011 Accepting new patients
Great Minds Academy, LLC CurrentSince Nov 26, 2023 Accepting new patients
Brazosport Rehabilitation & Wellness, LLC Occupational Therapist PastSince Apr 18, 2008 Accepting new patients
Alme Plus, LLC PastSince Apr 4, 2023 Accepting new patients
Fitness & Rehabilitation Services, LLC Occupational Therapist Past Accepting new patients

Locations

309 Plantation Dr
Lake Jackson, TX 77566
Phone (979) 418-7165

309 Plantation Dr
Ste L
Lake Jackson, TX 77566
Phone (979) 418-7165

309 Plantation Dr
Ste P
Lake Jackson, TX 77566
Phone (979) 401-0965

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.

NPI Registry JSON

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655942400000",
    "number": "1245216654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "337 SHERI LN",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775663269",
            "telephone_number": "281-229-0263",
            "fax_number": "800-419-5153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "337 SHERI LN",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775663269",
            "telephone_number": "281-229-0263",
            "fax_number": "800-419-5153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCIO",
        "first_name": "EDNA",
        "name_prefix": "Ms.",
        "credential": "OT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-12-16",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3264970",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Jackson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2022; 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.