Individual provider Active NPI

Lily A. Lucca-Bederka, PA

  • Physician Assistant
  • Jersey City, NJ
National Provider Identifier
1811630478
Registry record updated Apr 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
355 Grand St
Jersey City, NJ 07302-4321
Phone
(201) 915-2000
NPI assigned
Apr 20, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

355 Grand St
Jersey City, NJ 07302-4321

Mailing address

355 Grand St
Jersey City, NJ 07302-4321
Phone (201) 915-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230524002095 NJ Practitioner - Physician Assistant 2567828148 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rwjbh Observation Associates LLCGroup PAC ID 5193137503, 995 clinicians
Rwjbh Emergency Medicine Associates, LLCGroup PAC ID 0941612840, 826 clinicians

Practice addresses (Care Compare)

110 Rehill Ave
Somerville, NJ 08876-2519
Phone (908) 685-2200

225 Williamson St
Elizabeth, NJ 07202-3625
Phone (908) 994-5422

355 Grand St
Jersey City, NJ 07302-4321
Phone (201) 915-2000

519 Broadway
Bayonne, NJ 07002-3713
Phone (201) 716-5700

Hospital & facility affiliations

  • Jersey City Medical Center Hospital, Jersey City, NJ, CCN 310074

Merit-based Incentive Payment System (MIPS)

Final score
87.07 of 100Reported as group
Quality
76.5
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
94.87
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1650412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1811630478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 GRAND ST",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073024321",
            "telephone_number": "201-915-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 GRAND ST",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073024321",
            "telephone_number": "201-915-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCCA-BEDERKA",
        "first_name": "LILY",
        "middle_name": "A.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-20",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

Sources for this page

Verify at the official NPI Registry.