Kellie J Lustenberger, N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209006728 Issued in IL

Practice address

305 W. Jackson, Suite 100
New Horizons Obstetrics & Gynecology
Carbondale, IL 62901

Phone

(618) 457-0404

Fax

(618) 457-0440

NPI assigned

Oct 9, 2007

Sex

Female

Sole proprietor

No

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.

• Southern Illinois OB-GYN Associates, S.C.

  • Obstetrics & Gynecology Physician
  • Herrin, IL
  • NPI 1699838276

  IL

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Southern Illinois Hospital Services

  • General Acute Care Hospital
  • Carbondale, IL
  • NPI 1093801797

  Hospital

  Care Compare affiliation

Specialty

Nurse Practitioner

Education

Other, 2007

Medicare assignment

May accept Medicare assignment

Group practices

Southern Illinois OB-GYN Associates SC 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Hospital of Carbondale Hospital, Carbondale, IL, CCN 140164

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

Specialties & licenses 1

Addresses

The complete record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210723200000",
    "number": "1295923779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 W JACKSON ST STE 100",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011474",
            "telephone_number": "618-457-0404",
            "fax_number": "618-457-0440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W. JACKSON, SUITE 100",
            "address_2": "NEW HORIZONS OBSTETRICS & GYNECOLOGY",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "62901",
            "telephone_number": "618-457-0404",
            "fax_number": "618-457-0440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUSTENBERGER",
        "first_name": "KELLIE",
        "middle_name": "J",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-09",
        "last_updated": "2008-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209006728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Loggini, MD
• John Alan Longmire
• Alexis Elizabeth Lorinskas, PA-C
• Deandre Love
• Robert E Lowry, LCPC
• Darlene S Lutchka, MD
• William Lyman
• Mary C Lyons, PA
• Emily Margaret Macdonald
• Allison Magnuson, MD

• All providers in Carbondale, IL
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.