Samuel David Lustgarten, PHD

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

3717-57 Issued in WI

Practice address

702 N Blackhawk Ave Ste 205
Madison, WI 53705-3357

Phone

(720) 260-4362

Fax

(971) 999-0817

NPI assigned

Oct 28, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: samuellustgarten@tdh.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Samuel Lustgarten PHD LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Madison, WI
  • NPI 1427729227
  Medicare reassignment Authorized official
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567
  NPD

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

{
    "created_epoch": "1572220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672272000000",
    "number": "1477197929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 N BLACKHAWK AVE STE 205",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537053357",
            "telephone_number": "720-260-4362",
            "fax_number": "971-999-0817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 N BLACKHAWK AVE STE 205",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537053357",
            "telephone_number": "720-260-4362",
            "fax_number": "971-999-0817"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7409 SW Capitol Hwy Ste 207",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972192432",
            "country_code": "US",
            "telephone_number": "720-260-4362",
            "fax_number": "971-999-0817",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUSTGARTEN",
        "first_name": "SAMUEL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-28",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "OR",
            "license": "3178",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "WI",
            "license": "3717-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Lee Lunsford, LMFT
• Rebecca Luoh
• Ilir Lushaj
• Allan T Luskin, MD
• Susan Stone Luskin
• Emily Lustig, MSW
• Rocio Luisa Lutenbacher, LCSW
• Lutheran Social Services of Wisconsin and Upper Michigan, Inc.
• Leanne Lynne Lutz, MSN RN
• Megan Lutz

• Counseling Psychologist in Madison, WI
• Providers in Madison, WI by specialty
• Counseling Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.