Active NPI
Louis Philip Bucky, MD
- Plastic and Reconstructive Surgery Physician
- Ardmore, PA
National Provider Identifier
1609808757
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic and Reconstructive Surgery Physician
- License
- MD056328L
- Practice address
- 200 W Montgomery Ave
Ardmore, PA 19003-1416 - Phone
- (610) 649-2433
- Fax
- (215) 829-6327
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic and Reconstructive Surgery Physician | 2086S0122X | MD056328L | PA | Primary |
Addresses
Primary practice location
200 W Montgomery Ave
Ardmore, PA 19003-1416
Mailing address
200 W Montgomery Ave
Ardmore, PA 19003-1416
Phone (610) 649-2433
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0015400260004 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 20, 2024 through Sep 20, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trustees of the University of Pennsylvania | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Philadelphia, PA
- NPI 1124882949
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569542400000",
"number": "1609808757",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 W MONTGOMERY AVE",
"city": "ARDMORE",
"state": "PA",
"postal_code": "190031416",
"telephone_number": "610-649-2433",
"fax_number": "215-829-6327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 W MONTGOMERY AVE",
"city": "ARDMORE",
"state": "PA",
"postal_code": "190031416",
"telephone_number": "610-649-2433",
"fax_number": "215-829-6327"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKY",
"first_name": "LOUIS",
"middle_name": "PHILIP",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2019-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0122X",
"taxonomy_group": "",
"desc": "Surgery, Plastic and Reconstructive Surgery",
"state": "PA",
"license": "MD056328L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0015400260004",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ardmore, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2019; 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.