Active NPI
Lucas Phillips, MED, ATC, LAT
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Bloomington, IN
National Provider Identifier
1275819443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- License
- 3982
- Practice address
- 1001 E 17TH St
Bloomington, IN 47408-1590 - Phone
- (812) 855-7916
- NPI assigned
- Nov 1, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 36001524A | IN | |
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 3982 | OH | Primary |
Addresses
Primary practice location
1001 E 17TH St
Bloomington, IN 47408-1590
Mailing address
155 Miami St
Tiffin, OH 44883-2109
Phone (419) 448-3480
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3982 | OH | MD | Chiropractor |
| 36001524A | IN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522108800000",
"number": "1275819443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "155 MIAMI ST",
"city": "TIFFIN",
"state": "OH",
"postal_code": "448832109",
"telephone_number": "419-448-3480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 E 17TH ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474081590",
"telephone_number": "812-855-7916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "LUCAS",
"credential": "MED, ATC, LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-11-01",
"last_updated": "2018-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36001524A",
"primary": false
},
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "OH",
"license": "3982",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.