Alexis Ann Lucas, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA15472 Issued in TX

Practice address

3636 Executive Center Dr Ste G70
Austin, TX 78731-1628

Phone

(512) 371-9555

Fax

(512) 367-5756

NPI assigned

Dec 8, 2021

Last updated

Mar 11, 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 identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 11, 2022 through May 11, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

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.

• Pondworks PA

  • Psychiatry Physician
  • Austin, TX
  • NPI 1124139506
  NPD (past)

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

{
    "created_epoch": "1638921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646956800000",
    "number": "1427717305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12703 S 75TH EAST AVE",
            "city": "BIXBY",
            "state": "OK",
            "postal_code": "740081501",
            "telephone_number": "918-606-2146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3636 EXECUTIVE CENTER DR STE G70",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787311628",
            "telephone_number": "512-371-9555",
            "fax_number": "512-367-5756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCAS",
        "first_name": "ALEXIS",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-08",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA15472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS MEDICAL BOARD ID",
            "identifier": "737791",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "AUSTIN",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3636 Executive Center Dr Ste G70",
            "city": "Austin",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787311628",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Craig H Lubin, M.D.
• Abby Lubran, LCSW
• Paige Lubritz, RD LD
• Benson Luc, CRNA
• Ana Maria Luca
• Amy Lucas, RDN, LD
• Ashlea Mica Lucas, PA-C
• Bethany Lucas, RD, LD
• Beverly D. Lucas, LMSW
• Colleen Lucas, RN

• Physician Assistant in Austin, TX
• Providers in Austin, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.