Jason Harold Lustig, DDS MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

5776 Issued in LA

Practice address

7600 Fern Ave
Building 1400
Shreveport, LA 71105-5659

Phone

(318) 797-5812

Fax

(318) 797-0390

NPI assigned

Apr 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Maxillofacial SurgeryAlso: Oral Surgery

Education

Baylor College of Dentistry/Texas a&M University, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arklatex Oral and Maxillofacial Surgery a Partnership of ProfessionalGroup PAC ID 9739376864, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Arklatex Oral & Maxillofacial Surgery a Partnership of Professional de

  • Oral and Maxillofacial Surgery (Dentist)
  • Shreveport, LA
  • NPI 1003092545
  Medicare reassignment Care Compare group NPD
• Clifton Oral & Maxillofacial Surgery, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Clifton, NJ
  • NPI 1740361724
  NPD (past)

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185235200000",
    "number": "1750347498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7600 FERN AVE",
            "address_2": "BUILDING 1400",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055659",
            "telephone_number": "318-797-5812",
            "fax_number": "318-797-0390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 FERN AVE",
            "address_2": "BUILDING 1400",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055659",
            "telephone_number": "318-797-5812",
            "fax_number": "318-797-0390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUSTIG",
        "first_name": "JASON",
        "middle_name": "HAROLD",
        "credential": "DDS MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2007-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "LA",
            "license": "5776",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "22D102219000",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "050487",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "227864",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; 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.

Verify at the official NPI Registry.