NPIMap

Individual provider Active NPI

Kenneth Grant Lucero, M.D.

  • Family Medicine Physician
  • Blythe, CA
National Provider Identifier
1417079989
Registry record updated Feb 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G60508 Issued in CA
Practice address
1415 W Hobsonway
Blythe, CA 92225-1479
Phone
(760) 922-4981
Fax
(760) 922-4442
NPI assigned
Apr 4, 2007
Last updated
Feb 14, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G60508 CA Primary

Addresses

Primary practice location

1415 W Hobsonway
Blythe, CA 92225-1479

Mailing address

141 W Hobsonway Ste B
Blythe, CA 92225-1616
Phone (760) 574-7787

Other identifiers 1

IdentifierTypeStateIssuer
00G605082MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070605000594 CA Practitioner - Family Practice 7113947060 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of California, Geffen School of Medicine, 1985
Medicare assignment
May accept Medicare assignment
Group practices
Clinicas de Salud del Pueblo IncGroup PAC ID 5496657082, 42 clinicians

Practice addresses (Care Compare)

321 W Hobsonway
Suite C
Blythe, CA 92225-1651
Phone (760) 922-4981

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.25 of 100Reported as group
Quality
100
Promoting interoperability
73
Improvement activities
40
Cost
100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60508CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Desert View Medical Family Medicine CurrentSince Nov 1, 2012 Accepting new patients
Clinicas de Salud del Pueblo, Inc CurrentSince Apr 15, 2023 Accepting new patients
Clinicas de Salud del Pueblo, Inc Current Accepting new patients
Clinicas de Salud del Pueblo Inc. CurrentSince Apr 15, 2023 Accepting new patients
Clinicas de Salud del Pueblo, Inc. Past Accepting new patients
Palo Verde Health Care District Past Accepting new patients
Healthcare Partners Affiliates Medical Group Family Medicine Past Accepting new patients

Locations

1415 W Hobsonway
Blythe, CA 92225
Phone (760) 544-6996

205 N 1st St
Ste A
Blythe, CA 92225
Phone (760) 921-2342

321 W Hobsonway
Ste C
Blythe, CA 92225
Phone (760) 922-4981

1166 K St
Brawley, CA 92227
Phone (760) 344-3583

Interoperability endpoints

  • Direct secure messaging: kenneth.lucero.p1@direct.cdsdp.nextgenshare.com
  • Direct secure messaging: kenneth.lucero@3528.securemail.prognocis.com
  • Direct secure messaging: pvhklucero@yourcarecommunity.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Helping Hands Hospice, LLCBlythe, CA, CCN B51718 Hospice W-2 Managing Employee Dec 6, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739491200000",
    "number": "1417079989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 W HOBSONWAY STE B",
            "city": "BLYTHE",
            "state": "CA",
            "postal_code": "922251616",
            "telephone_number": "760-574-7787",
            "fax_number": "760-921-3471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 W HOBSONWAY",
            "city": "BLYTHE",
            "state": "CA",
            "postal_code": "922251479",
            "telephone_number": "760-922-4981",
            "fax_number": "760-922-4442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCERO",
        "first_name": "KENNETH",
        "middle_name": "GRANT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-04",
        "last_updated": "2025-02-14",
        "certification_date": "2025-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G60508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G605082",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blythe, CA

Sources for this page

Verify at the official NPI Registry.