NPIMap

Individual provider Active NPI

Luke Monell Wicke, DO

  • Family Medicine Physician
  • Joplin, MO
National Provider Identifier
1588926620
Registry record updated Jul 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2019012274 Issued in MO
Practice address
3126 S Jackson Ave Ste 200
Joplin, MO 64804
Phone
(417) 556-3465
NPI assigned
Jun 14, 2012
Last updated
Jul 19, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2019012274 MO Primary
General Practice Physician 208D00000X DOS-1551 HI

Addresses

Primary practice location

3126 S Jackson Ave Ste 200
Joplin, MO 64804

Mailing address

3126 S Jackson Ave Ste 200
Joplin, MO 64804-2500
Phone (417) 556-3465

Other practice location 1

Tripler Army Medical Center
1 Jarrett White Rd
Tamc, HI 96859-5001
Phone (808) 433-3300

Other practice location 2

Tripler Army Medical Center
1 Jarrett White Rd
Tamc, HI 96859-5001
Phone (808) 433-3300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20190708000333 MO Practitioner - Family Practice 3870828353 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Kansas City University of Physicians and Surgeons, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Joplin LLCGroup PAC ID 0547300196, 288 clinicians

Practice addresses (Care Compare)

6151 N Main St Rd
Mercy Clinic Joplin Stone's Corner
Webb City, MO 64870-8189
Phone (417) 781-0408

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DOS-1551HIMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Joplin LLC Family Medicine CurrentSince Jul 14, 2019 Accepting new patients
Mercy Southern Missouri Ambulatory Services LLC CurrentSince Feb 7, 2023 Accepting new patients
Alliance Radiology, PA PastSince Feb 7, 2023 Accepting new patients

Locations

94 Main St
Cassville, MO 65625
Phone (417) 782-7722

100 Mercy Way
Joplin, MO 64804
Phone (417) 556-2300

1421 S Range Line Rd
Ste C
Joplin, MO 64801
Phone (417) 434-9445

3126 S Jackson Ave
Ste 200
Joplin, MO 64804
Phone (417) 556-3465

2150 W Republic Rd
Ste 112
Springfield, MO 65807
Phone (417) 986-1291

6055 N Main Street Rd
Webb City, MO 64870
Phone (417) 206-0400

6151 N Main Street Rd
Webb City, MO 64870
Phone (417) 556-5350

Interoperability endpoints

  • Direct secure messaging: lwicke1030522@directc.mercy.net

Organizations & group practices 3

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563494400000",
    "number": "1588926620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3126 S JACKSON AVE STE 200",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648042500",
            "telephone_number": "417-556-3465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3126 S JACKSON AVE STE 200",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "64804",
            "telephone_number": "417-556-3465"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Tripler Army Medical Center",
            "address_2": "1 Jarrett White Rd",
            "address_purpose": "LOCATION",
            "city": "TAMC",
            "state": "HI",
            "postal_code": "968595001",
            "country_code": "US",
            "telephone_number": "808-433-3300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Tripler Army Medical Center",
            "address_2": "1 Jarrett White Rd",
            "address_purpose": "LOCATION",
            "city": "TAMC",
            "state": "HI",
            "postal_code": "968595001",
            "country_code": "US",
            "telephone_number": "808-433-3300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WICKE",
        "first_name": "LUKE",
        "middle_name": "MONELL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-14",
        "last_updated": "2019-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2019012274",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "HI",
            "license": "DOS-1551",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joplin, MO

Sources for this page

Verify at the official NPI Registry.