NPIMap

Individual provider Active NPI

Jaclyn Lustig, PAC

  • Medical Physician Assistant
  • Bethlehem, PA
National Provider Identifier
1245395318
Registry record updated Aug 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA052882 Issued in PA
Practice address
95 Highland Ave
Suite 130
Bethlehem, PA 18017-9424
Phone
(610) 868-1100
Fax
(610) 868-1111
NPI assigned
Dec 27, 2006
Last updated
Aug 19, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA052882 PA Primary

Addresses

Primary practice location

95 Highland Ave
Suite 130
Bethlehem, PA 18017-9424

Mailing address

95 Highland Ave
Suite 130
Bethlehem, PA 18017-9424
Phone (610) 868-1100

Other names 1

  • Jaclyn Lustig Professional name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070212000006 PA Practitioner - Physician Assistant 4587666169 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Progressive Physician Assoc IncGroup PAC ID 1355243809, 164 clinicians

Practice addresses (Care Compare)

100 St Lukes LN
Stroudsburg, PA 18360-6217
Phone (484) 526-4000

1736 Hamilton St
Allentown, PA 18104-5656
Phone (610) 868-1100

1872 St Lukes Blvd
Easton, PA 18045-5669
Phone (610) 868-1100

210 Edgemont Ave
Ardmore, PA 19003-2705
Phone (610) 868-1100

3 Parkinsons Rd
East Stroudsburg, PA 18301-8087
Phone (610) 868-8110

360 W Riddle St
Coaldale, PA 18218-1027
Phone (610) 868-1100

801 Ostrm St
Bethlehem, PA 18015-1000
Phone (610) 868-1100

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke's Physician Group, Inc. CurrentSince Oct 6, 2014 Accepting new patients
St Luke's Physician Group Inc CurrentSince Oct 6, 2014 Accepting new patients
Progressive Physician Assoc, Inc. Past Accepting new patients

Locations

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

Organizations & group practices 5

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 10

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": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439942400000",
    "number": "1245395318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 HIGHLAND AVE",
            "address_2": "SUITE 130",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180179424",
            "telephone_number": "610-868-1100",
            "fax_number": "610-868-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 HIGHLAND AVE",
            "address_2": "SUITE 130",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180179424",
            "telephone_number": "610-868-1100",
            "fax_number": "610-868-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUSTIG",
        "first_name": "JACLYN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-27",
        "last_updated": "2015-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA052882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "LUSTIG",
            "credential": "PAC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Bethlehem, PA

Sources for this page

Verify at the official NPI Registry.