Dominique Lanelle Luckey, M.D.

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

A69874 Issued in CA

Practice address

1701 E Cesar Chavez Ave
Suite #402
Los Angeles, CA 90033-2464

Phone

(323) 317-9200

Fax

(323) 317-9206

NPI assigned

Sep 12, 2005

Reactivated

Mar 29, 2006

Last updated

Oct 18, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

Howard University College of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

White Memorial Gynecological and Obstetrical Medical GroupGroup PAC ID 2062560907, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health White Memorial Hospital, Los Angeles, CA, CCN 050103

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: dml115pcs@m1146.primeclinicalsystems.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• White Memorial Gynecological and Obstetrical Medical Group

  • Obstetrics & Gynecology Physician
  • Los Angeles, CA
  • NPI 1811060262
  Medicare reassignment Care Compare group
• Beverly Health & Birthing Center

  • Specialist
  • Los Angeles, CA
  • NPI 1225097025
  NPD (past)
• FCS - Highland Park

  • Family Medicine Physician
  • Los Angeles, CA
  • NPI 1437328325
  NPD (past)
• White Memorial Medical Center

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1215927470
  NPD (past)

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

• White Memorial Medical Center

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1215927470
  Care Compare affiliation

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

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192665600000",
    "number": "1326033804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5823 YORK BLVD",
            "address_2": "#1",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900422634",
            "telephone_number": "323-255-3437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 E CESAR CHAVEZ AVE",
            "address_2": "SUITE #402",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332464",
            "telephone_number": "323-317-9200",
            "fax_number": "323-317-9206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCKEY",
        "first_name": "DOMINIQUE",
        "middle_name": "LANELLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-12",
        "last_updated": "2007-10-18",
        "deactivation_date": "2006-03-22",
        "reactivation_date": "2006-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "CA",
            "license": "A69874",
            "primary": true
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "CA",
            "license": "A69874",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00A698740",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A698740",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00384423",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Lane Lucier, MD
• Klarrissa Lucio
• James Vernon Luck Jr., M.D.
• Kanitha Luckanavanich
• Steven Luckett
• Lucky Diagnostic,Inc
• Lucky Medical Transportatio, Inc (Lucky Medical Transportation, Inc)
• Lucky Medical Trasportation Inc (DBA Lucky Medical Trasportation)
• Lora Luczywo, IBCLC
• John K Ludington, P.A. - C

• Gynecology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; 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.