Active NPI
Lucas Pettit
- Medical Physician Assistant
- Cicero, NY
National Provider Identifier
1245787159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 8003 Brewerton Rd
Cicero, NY 13039-9528 - Phone
- (315) 288-4006
- Fax
- (315) 288-4760
- NPI assigned
- Sep 8, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | Primary |
Addresses
Primary practice location
8003 Brewerton Rd
Cicero, NY 13039-9528
Mailing address
3292 Black St
Scipio Center, NY 13147-3172
Phone (315) 406-6385
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY, IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Port City Emergency Physicians LLP | Current | Accepting new patients | |
| Port City Emergency Physicians LLP | Current | Accepting new patients | |
| Wellnow Urgent Care, PC | Past | Accepting new patients |
Locations
110 W 6th St
Oswego, NY 13126
Phone (315) 349-5511
Interoperability endpoints
- lpettit@hiemail.healtheconnections.org
Organizations & group practices 7
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.
-
- Internal Medicine Physician
- Elmira, NY
- NPI 1033352372
-
- Emergency Medicine Physician
- Oswego, NY
- NPI 1134370547
-
- Urgent Care Clinic/Center
- Chicago, IL
- NPI 1205814118
-
- Emergency Medicine Physician
- Hamilton, NY
- NPI 1316395460
-
- Emergency Medicine Physician
- Central Square, NY
- NPI 1669721296
-
- Urgent Care Clinic/Center
- Jamestown, NY
- NPI 1770850224
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473292800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575331200000",
"number": "1245787159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3292 BLACK ST",
"city": "SCIPIO CENTER",
"state": "NY",
"postal_code": "131473172",
"telephone_number": "315-406-6385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8003 BREWERTON RD",
"city": "CICERO",
"state": "NY",
"postal_code": "130399528",
"telephone_number": "315-288-4006",
"fax_number": "315-288-4760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIT",
"first_name": "LUCAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-09-08",
"last_updated": "2019-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cicero, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2019; 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.