Individual provider Active NPI

Rebecca Lucas, SLP

  • Speech-Language Pathologist
  • Ardmore, OK
National Provider Identifier
1245848050
Registry record updated Jul 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
CF247 Issued in OK
Practice address
1107 W Broadway St
Ardmore, OK 73401-2833
Phone
(580) 226-5566
Fax
(580) 226-5567
NPI assigned
Jul 17, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X CF247 OK Primary

Addresses

Primary practice location

1107 W Broadway St
Ardmore, OK 73401-2833

Mailing address

1405 4TH Ave NW # 296
Ardmore, OK 73401-2708
Phone (580) 226-5566

Other practice location 1

410 W Lillie Blvd
Madill, OK 73446-1270
Phone (580) 872-4277

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address erinw@prohabsecure.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201026001698 OK Practitioner - Qualified Speech Language Pathologist 0345660676 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Rehab LLC Speech-Language Pathologist CurrentSince Oct 1, 2020 Accepting new patients

Locations

1107 W Broadway St
Ardmore, OK 73401
Phone (580) 226-5566

1405 4th Ave NW
Ardmore, OK 73401
Phone (580) 226-5566

410 W Lillie Blvd
Madill, OK 73446
Phone (580) 226-5566

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": "1594944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594944000000",
    "number": "1245848050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 4TH AVE NW # 296",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734012708",
            "telephone_number": "580-226-5566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 W BROADWAY ST",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734012833",
            "telephone_number": "580-226-5566",
            "fax_number": "580-226-5567"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "410 W Lillie Blvd",
            "address_purpose": "LOCATION",
            "city": "Madill",
            "state": "OK",
            "postal_code": "734461270",
            "country_code": "US",
            "telephone_number": "580-872-4277",
            "fax_number": "580-872-4261",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUCAS",
        "first_name": "REBECCA",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-17",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OK",
            "license": "CF247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "erinw@prohabsecure.com",
            "affiliation": "N",
            "endpointDescription": "secure email server",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1107 W Broadway St",
            "city": "Ardmore",
            "state": "OK",
            "country_code": "US",
            "postal_code": "734012833",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.