Individual provider Active NPI

Shannon Renae Lucas

  • Social Worker
  • Sapulpa, OK
National Provider Identifier
1285241539
Registry record updated Dec 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
8528 Issued in OK
Practice address
23 E Ross Ave
Sapulpa, OK 74066-6423
Phone
(918) 227-2016
Fax
(918) 224-1125
NPI assigned
Sep 29, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Social Worker 104100000X 8528 OK Primary

Addresses

Primary practice location

23 E Ross Ave
Sapulpa, OK 74066-6423

Mailing address

23 E Ross Ave
Sapulpa, OK 74066-6423
Phone (918) 227-2016

Other practice location 1

2325 S Harvard Ave
Tulsa, OK 74114-3300
Phone (918) 724-8006

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260304001798 OK Practitioner - Clinical Social Worker 8921580416 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Creoks Mental Health ServicesGroup PAC ID 0749591469, 39 clinicians

Practice addresses (Care Compare)

4103 S Yale Ave
Suite B
Tulsa, OK 74135-6002
Phone (918) 382-7300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8528OKMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Creoks Mental Health CurrentSince Jan 18, 2026 Accepting new patients
Creoks Mental Health Services Multi-Specialty CurrentSince Jan 18, 2026 Accepting new patients

Locations

23 E Ross Ave
Sapulpa, OK 74066
Phone (918) 216-4999

4103 S Yale Ave
Ste B
Tulsa, OK 74135
Phone (918) 382-7302

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": "1601337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735344000000",
    "number": "1285241539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 E ROSS AVE",
            "city": "SAPULPA",
            "state": "OK",
            "postal_code": "740666423",
            "telephone_number": "918-227-2016",
            "fax_number": "918-224-1125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 E ROSS AVE",
            "city": "SAPULPA",
            "state": "OK",
            "postal_code": "740666423",
            "telephone_number": "918-227-2016",
            "fax_number": "918-224-1125"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2325 S Harvard Ave",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741143300",
            "country_code": "US",
            "telephone_number": "918-724-8006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUCAS",
        "first_name": "SHANNON",
        "middle_name": "RENAE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-29",
        "last_updated": "2024-12-28",
        "certification_date": "2024-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OK",
            "license": "8528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sapulpa, OK

Sources for this page

Verify at the official NPI Registry.