Active NPI
David Grant Lukomsky, PA-C
- Physician Assistant
- Fort Bragg, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA60459
- Practice address
- 721 River Dr Ste C
Fort Bragg, CA 95437 - Phone
- (707) 961-4995
- NPI assigned
- Dec 10, 2021
- Last updated
- Dec 10, 2021
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA60459 | CA | Primary |
Addresses
Primary practice location
721 River Dr Ste C
Fort Bragg, CA 95437
Mailing address
931 W Great Basin Dr
Meridian, ID 83646-4574
Phone (208) 724-9391
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
700 River Dr
Fort Bragg, CA 95437-5403
Phone (707) 961-1234
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 80.98 of 100
- Quality
- 73.31
- Promoting interoperability
- 92
- Improvement activities
- 40
- Cost
- 62
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA60459 | CA | MD | Physician Assistant |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Mendocino Coast District Hospital
- Critical Access Hospital
- Fort Bragg, CA
- NPI 1538113725
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Mendocino Coast District Hospital
- Critical Access Hospital
- Fort Bragg, CA
- NPI 1538113725
-
dba Adventist Health Ukiah Valley
- General Acute Care Hospital
- Ukiah, CA
- NPI 1235120676
-
dba Adventist Health Howard Memorial
- Critical Access Hospital
- Willits, CA
- NPI 1356339543
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639094400000",
"number": "1669131272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "931 W GREAT BASIN DR",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836464574",
"telephone_number": "208-724-9391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "721 RIVER DR STE C",
"city": "FORT BRAGG",
"state": "CA",
"postal_code": "95437",
"telephone_number": "707-961-4995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUKOMSKY",
"first_name": "DAVID",
"middle_name": "GRANT",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-12-10",
"last_updated": "2021-12-10",
"certification_date": "2021-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA60459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Bragg, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.