NPIMap

Individual provider Active NPI

Andrea Lee Luckett, CRNA

  • Certified Registered Nurse Anesthetist
  • Louisville, KY
National Provider Identifier
1619951514
Registry record updated Mar 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3004813 Issued in KY
Practice address
3920 Dutchmans LN
Louisville, KY 40207-4702
Phone
(502) 259-6710
Fax
(502) 259-6704
NPI assigned
Dec 5, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 1077892 KY
Certified Registered Nurse Anesthetist 367500000X 3004813 KY Primary

Addresses

Primary practice location

3920 Dutchmans LN
Louisville, KY 40207-4702

Mailing address

PO Box 909
Louisville, KY 40201-0909
Phone (502) 588-0328

Other identifiers 6

IdentifierTypeStateIssuer
50014417OtherKYPASSPORT
201363600MedicaidIN
000000477092OtherKYBLUE SHIELD
0958722OtherRAILROAD MEDICARE
2783422000OtherKYPASSPORT ADVANTAGE
7100110260MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060522000081 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 5799796140 Reassigns benefits to 1 organization
I20130627000468 IN Practitioner - Certified Registered Nurse Anesthetist (Crna) 5799796140 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Louisville Physicians IncGroup PAC ID 3476725599, shared by 5 NPIs, 1,438 clinicians

Practice addresses (Care Compare)

1305 Wall St
Ulp Eye Specialists
Jeffersonville, IN 47130-3853
Phone (502) 852-7445

3920 Dutchmans LN
Louisville, KY 40207-4702
Phone (502) 852-5341

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.96 of 100Reported as group
Quality
56.12
Promoting interoperability
100
Improvement activities
40
Cost
73.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1077892KYMDCertified Registered Nurse Anesthetist
3004813KYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Louisville Physicians, Inc. CurrentSince Jan 1, 2023 Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Jan 1, 2023 Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Jan 1, 2023 Accepting new patients
University of Louisville Physicians, Inc. Current Accepting new patients
University of Louisville Physicians, Inc Current Accepting new patients

Locations

7752 Solution Ctr
Chicago, IL 60677

2051 Clevidence Blvd
Clarksville, IN 47129
Phone (812) 280-6650

200 Missouri Ave
Jeffersonvlle, IN 47130
Phone (812) 920-0055

1305 Wall St
Jeffersonvlle, IN 47130
Phone (812) 288-8005

3920 Dutchmans Ln
Louisville, KY 40207
Phone (502) 259-6000

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

Organizations & group practices 5

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 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1619951514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 909",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402010909",
            "telephone_number": "502-588-0328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3920 DUTCHMANS LN",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074702",
            "telephone_number": "502-259-6710",
            "fax_number": "502-259-6704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCKETT",
        "first_name": "ANDREA",
        "middle_name": "LEE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-05",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "1077892",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3004813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "50014417",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201363600",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000000477092",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "0958722",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT ADVANTAGE",
            "identifier": "2783422000",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100110260",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.