NPIMap

Individual provider Active NPI

Nicholas Daniel Lukacs, D.O.

  • Otolaryngology/Facial Plastic Surgery Physician
  • Charlotte, NC
National Provider Identifier
1790804813
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
768047 Issued in MI
Practice address
8924 Blakeney Professional Dr
Charlotte, NC 28277-6660
Phone
(704) 703-1080
Fax
(704) 703-1090
NPI assigned
Mar 28, 2007
Last updated
Feb 1, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 768047 MI Primary

Addresses

Primary practice location

8924 Blakeney Professional Dr
Charlotte, NC 28277-6660

Mailing address

8924 Blakeney Professional Dr
Charlotte, NC 28277-6660
Phone (704) 703-1080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090618000324 NC Practitioner - Otolaryngology 3375693039 Reassigns benefits to 2 organizations
I20090729000724 SC Practitioner - Otolaryngology 3375693039 Practice locations: Fort Mill, SC

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Michigan State University College of Osteopathic Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Queen City Ear Nose and Throat PLLCGroup PAC ID 0941531487, 7 clinicians
Forsyth Medical Group, LLCGroup PAC ID 3678478054, 47 clinicians

Practice addresses (Care Compare)

1994 Wellness Blvd
Suite 210
Monroe, NC 28110-7768
Phone (704) 703-1080

8924 Blakeney Professional Dr
Charlotte, NC 28277-6660
Phone (704) 703-1080

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
768047MIMDOtolaryngology/Facial Plastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Queen City Ear Nose and Throat PLLC CurrentSince Aug 10, 2019 Accepting new patients
Forsyth Medical Group LLC CurrentSince Jan 13, 2026 Accepting new patients
Forsyth Medical Group LLC CurrentSince Jan 13, 2026 Accepting new patients
Cornerstone Ear Nose & Throat PA CurrentSince Mar 19, 2023 Accepting new patients
Forsyth Memorial Hospital Inc Past Accepting new patients

Locations

8924 Blakeney Professional Dr
Charlotte, NC 28277
Phone (704) 703-1080

1107 Reynolds St
Monroe, NC 28112
Phone (704) 289-8220

1994 Wellness Blvd
Ste 210
Monroe, NC 28110
Phone (704) 290-5995

2536 Lengers Way
Indian Land, SC 29707
Phone (803) 313-3294

Interoperability endpoints

  • Direct secure messaging: nicholas.lukacs.1@27575.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1790804813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8924 BLAKENEY PROFESSIONAL DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282776660",
            "telephone_number": "704-703-1080",
            "fax_number": "704-752-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8924 BLAKENEY PROFESSIONAL DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282776660",
            "telephone_number": "704-703-1080",
            "fax_number": "704-703-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUKACS",
        "first_name": "NICHOLAS",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-28",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MI",
            "license": "768047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.