NPIMap

Individual provider Active NPI

Robert Allen Lustig, MD

  • Therapeutic Radiology Physician
  • Philadelphia, PA
National Provider Identifier
1275569964
Registry record updated Dec 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Therapeutic Radiology PhysicianTaxonomy code 2085R0203X
License
MD014859 Issued in PA
Practice address
3400 Civic Center Blvd
Concourse Level
Philadelphia, PA 19104-5127
Phone
(215) 662-2428
NPI assigned
Jun 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Therapeutic Radiology Physician 2085R0203X MD014859 PA Primary

Addresses

Primary practice location

3400 Civic Center Blvd
Concourse Level
Philadelphia, PA 19104-5127

Mailing address

3400 Civic Center Blvd
TRC 2 West
Philadelphia, PA 19104-5127
Phone (215) 662-2428

Other identifiers 1

IdentifierTypeStateIssuer
0006979790001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050314000498 PA Practitioner - Radiation Oncology 1951356930 Reassigns benefits to 1 organization
I20050719000023 NJ Practitioner - Radiation Oncology 1951356930 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Jefferson Medical College of Thomas Jefferson University, 1969
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

3400 Civic Ctr Blvd
Philadelphia, PA 19104-5127
Phone (215) 662-2428

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD014859PAMDTherapeutic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn - Medical Group CurrentSince May 1, 2015 Accepting new patients
Clinical Health Care Associates of New Jersey, P.C. CurrentSince Jan 7, 2023 Accepting new patients
University of Penn-Medical Group CurrentSince May 1, 2015 Accepting new patients
Clinical Health Care Associates of New Jersey, PC CurrentSince Jan 7, 2023 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
University of Penn - Medical Group Past Accepting new patients

Locations

1865 Route 70 E
Ste 220
Cherry Hill, NJ 08003
Phone (856) 429-0505

3205 Fire Rd
Egg Hbr Twp, NJ 08234
Phone (609) 407-1113

1001 Chesterbrook Blvd
Berwyn, PA 19312
Phone (610) 576-7500

599 W State St
Ste 103
Doylestown, PA 18901
Phone (267) 880-2710

3400 Civic Center Blvd
#2W
Philadelphia, PA 19104
Phone (215) 614-1618

3400 Spruce St
Fl 2
Philadelphia, PA 19104
Phone (215) 662-2428

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

3400 Convention Ave
Philadelphia, PA 19104
Phone (215) 662-2300

701 E Marshall St
West Chester, PA 19380
Phone (610) 431-5000

800 Spruce St
William Penn Annex West, PA 19107
Phone (215) 829-3867

Organizations & group practices 6

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.

Hospital & facility affiliations 5

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": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418083200000",
    "number": "1275569964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "TRC 2 WEST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-662-2428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "CONCOURSE LEVEL",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-662-2428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUSTIG",
        "first_name": "ROBERT",
        "middle_name": "ALLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-24",
        "last_updated": "2014-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "PA",
            "license": "MD014859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006979790001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.