Individual provider Active NPI

Jaclyn Lunsford

  • Physician Assistant
  • Edgewood, KY
National Provider Identifier
1275903320
Registry record updated Aug 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
200 Medical Village Dr
Edgewood, KY 41017
Phone
(859) 301-5901
Fax
(859) 301-5940
NPI assigned
Oct 1, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

200 Medical Village Dr
Edgewood, KY 41017

Mailing address

PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 301-5901

Other identifiers 2

IdentifierTypeStateIssuer
0150184MedicaidOH
7100388160MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151123000660 KY Practitioner - Physician Assistant 1557661691 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Medical Group IncGroup PAC ID 2163326240, 803 clinicians

Practice addresses (Care Compare)

300 Barnes Rd
Williamstown, KY 41097-9483
Phone (859) 824-8400

334 Thomas More Pkwy
Crestview Hills, KY 41017-3464
Phone (859) 301-5901

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as apm
Quality
86.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, Inc. CurrentSince Nov 9, 2015 Accepting new patients
Summit Medical Group, Inc. Physician Assistant CurrentSince Nov 9, 2015 Accepting new patients

Locations

334 Thomas More Pkwy
Crestview Hills, KY 41017
Phone (859) 331-6065

334 Thomas More Pkwy
Ste 200
Crestview Hills, KY 41017
Phone (859) 344-3737

200 Medical Village Dr
Edgewood, KY 41017
Phone (859) 301-5900

1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

Organizations & group practices 3

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": "1443657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535587200000",
    "number": "1275903320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635283",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635283",
            "telephone_number": "859-301-5901",
            "fax_number": "859-301-5940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MEDICAL VILLAGE DR",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "41017",
            "telephone_number": "859-301-5901",
            "fax_number": "859-301-5940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUNSFORD",
        "first_name": "JACLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-01",
        "last_updated": "2018-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0150184",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100388160",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, KY

Sources for this page

Verify at the official NPI Registry.