Individual provider Active NPI

Charles J Lutz, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Syracuse, NY
National Provider Identifier
1477506582
Registry record updated Feb 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
223983 Issued in NY
Practice address
104 Union Ave
Suite 1001-1002
Syracuse, NY 13203-1843
Phone
(315) 423-7192
Fax
(315) 423-8013
NPI assigned
May 18, 2006
Last updated
Feb 11, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 223983 NY Primary

Addresses

Primary practice location

104 Union Ave
Suite 1001-1002
Syracuse, NY 13203-1843

Mailing address

104 Union Ave
Suite 1001-1002
Syracuse, NY 13203-1843
Phone (315) 423-7192

Other identifiers 1

IdentifierTypeStateIssuer
02298608MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100304000495 NY Practitioner - Cardiac Surgery 5597800391 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiac Surgery
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Josephs Medical PCGroup PAC ID 4688855844, 388 clinicians
United Medical Associates PCGroup PAC ID 0345144978, 229 clinicians

Practice addresses (Care Compare)

104 Union Ave
Suite 10011002
Syracuse, NY 13203-1843
Phone (315) 423-7192

30 Harrison St
Suite 250
Johnson City, NY 13790-2176
Phone (607) 763-6580

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)92
Pacemaker insertion or repair1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
223983NYMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
United Medical Associates PC CurrentSince Oct 1, 2023 Accepting new patients
St. Joseph's Physician Health, P.C. CurrentSince Mar 1, 2013 Accepting new patients
United Medical Associates, P.C. CurrentSince Oct 1, 2023 Accepting new patients
St Josephs Medical PC CurrentSince Jan 1, 2016 Accepting new patients
North Medical PC Current Accepting new patients
St Josephs Hospital Health Center Past Accepting new patients

Locations

30 Harrison St
Ste 250
Johnson City, NY 13790
Phone (607) 763-6580

33-57 Harrison St
Johnson City, NY 13790
Phone (607) 763-6412

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

104 Union Ave
Syracuse, NY 13203
Phone (315) 422-4442

104 Union Ave
Ste 1001
Syracuse, NY 13203
Phone (315) 423-7192

104 Union Ave
Ste 10011002
Syracuse, NY 13203
Phone (315) 423-7192

104 Union Ave
Ste 806
Syracuse, NY 13203
Phone (315) 423-7192

301 Prospect Ave
Syracuse, NY 13203
Phone (315) 448-5111

Interoperability endpoints

  • Direct secure messaging: clutz2367051@direct.trinity-health.org

Organizations & group practices 6

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": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455148800000",
    "number": "1477506582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 UNION AVE",
            "address_2": "SUITE 1001-1002",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132031843",
            "telephone_number": "315-423-7192",
            "fax_number": "315-423-8013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 UNION AVE",
            "address_2": "SUITE 1001-1002",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132031843",
            "telephone_number": "315-423-7192",
            "fax_number": "315-423-8013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUTZ",
        "first_name": "CHARLES",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2016-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NY",
            "license": "223983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02298608",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.