Active NPI
Michael Rudolph Lucero, PA-C
- Physician Assistant
- Knoxville, TN
National Provider Identifier
1790491298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5375
- Practice address
- 1050 Nod St
Knoxville, TN 37932-3717 - Phone
- (505) 328-2236
- NPI assigned
- Jan 27, 2023
- 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 | 5375 | TN | Primary |
Addresses
Primary practice location
1050 Nod St
Knoxville, TN 37932-3717
Mailing address
1050 Nod St
Knoxville, TN 37932-3717
Phone (505) 328-2236
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5375 | TN | MD | Speech-Language Pathologist |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674777600000",
"number": "1790491298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1050 NOD ST",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379323717",
"telephone_number": "505-328-2236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 NOD ST",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379323717",
"telephone_number": "505-328-2236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCERO",
"first_name": "MICHAEL",
"middle_name": "RUDOLPH",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-01-27",
"last_updated": "2023-01-27",
"certification_date": "2023-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TN",
"license": "5375",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Knoxville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.