Individual provider Active NPI

Jose E. Lucena, MD

  • Neonatal-Perinatal Medicine Physician
  • Sunrise, FL
National Provider Identifier
1336129501
Registry record updated Mar 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
K1535 Issued in TX
Practice address
1613 Harrison Pkwy
#200
Sunrise, FL 33323-2853
Phone
(954) 838-2371
NPI assigned
Jan 22, 2006
Last updated
Mar 21, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X K1535 TX Primary

Addresses

Primary practice location

1613 Harrison Pkwy
#200
Sunrise, FL 33323-2853

Mailing address

PO Box 816209
Hollywood, FL 33081-0209

Other identifiers 7

IdentifierTypeStateIssuer
124634004MedicaidTX
124634008MedicaidTX
124634006MedicaidTX
124634005MedicaidTX
124634007MedicaidTX
124634009MedicaidTX
124634010MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20151014001984 TX Practitioner - Pediatric Medicine 4880903822 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
K1535TXMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Acclaim Physician Group, Inc CurrentSince May 1, 2016 Accepting new patients
Tarrant County Hospital District Past Accepting new patients

Locations

1350 S Main St
Fl 1
Fort Worth, TX 76104
Phone (817) 702-3701

1500 S Main St
Ft Worth, TX 76104
Phone (817) 921-3431

Interoperability endpoints

  • Direct secure messaging: jlucena50717@direct.jpshealth.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1137888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458518400000",
    "number": "1336129501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 816209",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330810209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1613 HARRISON PKWY",
            "address_2": "#200",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232853",
            "telephone_number": "954-838-2371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCENA",
        "first_name": "JOSE",
        "middle_name": "E.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-22",
        "last_updated": "2016-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "TX",
            "license": "K1535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124634004",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124634008",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124634006",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124634005",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124634007",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124634009",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124634010",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunrise, FL

Sources for this page

Verify at the official NPI Registry.