Nina Dewi Lucas, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2012-01569 Issued in NC

Practice address

905 Halstead Blvd Ste 29
Elizabeth City, NC 27909-6816

Phone

(252) 698-0345

Fax

(252) 698-0346

NPI assigned

Apr 23, 2009

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Nina Lucas Beteta Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Mar 1, 2017 through Mar 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Memorial Hospital at Gulfport

  dba Memorial Emergency Physicians

  • Emergency Medicine Physician
  • Gulfport, MS
  • NPI 1962780379
  NPD (past)

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

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1396989109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 HALSTEAD BLVD STE 29",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279096816",
            "telephone_number": "252-698-0345",
            "fax_number": "252-698-0346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 HALSTEAD BLVD STE 29",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279096816",
            "telephone_number": "252-698-0345",
            "fax_number": "252-698-0346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCAS",
        "first_name": "NINA",
        "middle_name": "DEWI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-23",
        "last_updated": "2022-07-21",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2012-01569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NINA",
            "last_name": "BETETA",
            "middle_name": "LUCAS",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sachin Logani, MD
• Casey Long
• Lonnie's Heart of Hope
• Love You More Counseling & Consulting PLLC
• Kristen Nicole Lovell, BCBA, LBA
• Daniel H Lynam, PA C
• Lindsey Hassell Lynam, RPH
• Brittany N Lysik, DPT
• M-a-D Medical Supplies & Equipment
• Emilie Macdonald, RBT

• Family Medicine Physician in Elizabeth City, NC
• Providers in Elizabeth City, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.