Active NPI
Jesse Luckett, LMT
- Contractor
- Portland, OR
National Provider Identifier
1629337555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 7005
- Practice address
- 52 NE Fremont St
Portland, OR 97212-2027 - Phone
- (503) 381-6636
- NPI assigned
- May 12, 2012
- Last updated
- May 12, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Contractor | 171W00000X | 7005 | OR | Primary |
Addresses
Primary practice location
52 NE Fremont St
Portland, OR 97212-2027
Mailing address
52 NE Fremont St
Portland, OR 97212-2027
Phone (503) 381-6636
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7005 | OR | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1336780800000",
"number": "1629337555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "52 NE FREMONT ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972122027",
"telephone_number": "503-381-6636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "52 NE FREMONT ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972122027",
"telephone_number": "503-381-6636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCKETT",
"first_name": "JESSE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-05-12",
"last_updated": "2012-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "OR",
"license": "7005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.