Active NPI
Lucas Ray Moake
- Student in an Organized Health Care Education/Training Program
- Lebanon, IL
National Provider Identifier
1780545863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 701 College Rd
Lebanon, IL 62254-1291 - Phone
- (618) 232-7228
- NPI assigned
- Nov 19, 2025
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | IL | Primary |
Addresses
Primary practice location
701 College Rd
Lebanon, IL 62254-1291
Mailing address
200 Mascoutah Ave Apt 1
Belleville, IL 62220-3885
Phone (618) 964-0210
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1763510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1763510400000",
"number": "1780545863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 MASCOUTAH AVE APT 1",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622203885",
"telephone_number": "618-964-0210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 COLLEGE RD",
"city": "LEBANON",
"state": "IL",
"postal_code": "622541291",
"telephone_number": "618-232-7228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOAKE",
"first_name": "LUCAS",
"middle_name": "RAY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-11-19",
"last_updated": "2025-11-19",
"certification_date": "2025-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.