Active NPI
Thomas Lupp II
- Clinical Medical Laboratory
- Erie, PA
National Provider Identifier
1417360462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- License
- 1108070014
- Practice address
- 4125 Longview Ave
Erie, PA 16510-3535 - Phone
- (814) 860-0777
- NPI assigned
- Jun 7, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Clinical Medical Laboratory | 291900000X | |||
| Clinical Medical Laboratory | 291U00000X | 4830 | HI | |
| Clinical Medical Laboratory | 291U00000X | 1108070014 | Primary | |
| Clinical Medical Laboratory | 291U00000X | 44317 |
Addresses
Primary practice location
4125 Longview Ave
Erie, PA 16510-3535
Mailing address
4125 Longview Ave
Erie, PA 16510-3535
Phone (814) 860-0777
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4830 | Other | HI | STATE OF HAWAII MLT |
| 1108070014 | Other | US DEPT OF HHS - CLINICAL LABORATORY TECHNOLOGIST | |
| 44317 | Other | ASCP MLT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4830 | HI | MD | Clinical Medical Laboratory |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402099200000",
"number": "1417360462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4125 LONGVIEW AVE",
"city": "ERIE",
"state": "PA",
"postal_code": "165103535",
"telephone_number": "814-860-0777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4125 LONGVIEW AVE",
"city": "ERIE",
"state": "PA",
"postal_code": "165103535",
"telephone_number": "814-860-0777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUPP",
"first_name": "THOMAS",
"name_suffix": "II",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-07",
"last_updated": "2014-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "291900000X",
"taxonomy_group": "",
"desc": "Military Clinical Medical Laboratory",
"state": null,
"license": null,
"primary": false
},
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": "HI",
"license": "4830",
"primary": false
},
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": "1108070014",
"primary": true
},
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": "44317",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF HAWAII MLT",
"identifier": "4830",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "US DEPT OF HHS - CLINICAL LABORATORY TECHNOLOGIST",
"identifier": "1108070014",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASCP MLT",
"identifier": "44317",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.