NPIMap

Individual provider Active NPI

Michael Walter Lusko, D.O.

  • Emergency Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1811953524
Registry record updated May 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OS3713 Issued in FL
Practice address
800 Prudential Dr
Suite 713
Jacksonville, FL 32207-8202
Phone
(904) 396-5682
Fax
(904) 346-0864
NPI assigned
Apr 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 21, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X OS3713 FL Primary

Addresses

Primary practice location

800 Prudential Dr
Suite 713
Jacksonville, FL 32207-8202

Mailing address

9824 Scott Mill Rd
Jacksonville, FL 32257-5845
Phone (904) 737-2314

Other identifiers 3

IdentifierTypeStateIssuer
82132OtherFLBLUE CROSS
000762748CMedicaidGA
069703600MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070811000000 FL Practitioner - Emergency Medicine 9638260235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Physicians IncGroup PAC ID 7911811435, 105 clinicians

Practice addresses (Care Compare)

1320 Roberts Dr
Jacksonville Beach, FL 32250-3253
Phone (904) 396-5682

14534 Old Saint Augustine Rd
Suite 3110
Jacksonville, FL 32258-2617
Phone (904) 396-5682

1747 Baptist Clay Dr
Suite 250
Fleming Island, FL 32003-8502
Phone (904) 516-1000

836 Prudential Dr
Suite 105
Jacksonville, FL 32207-8300
Phone (904) 396-5682

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
98
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue722

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Inc Emergency Medicine CurrentSince Nov 20, 2006 Accepting new patients
Emergency Physicians Inc Emergency Medicine CurrentSince Nov 20, 2006 Accepting new patients
Florida Em-I Medical Services PA Emergency Medicine Past Accepting new patients
Belfort Emergency Physicians Emergency Medicine Past Accepting new patients

Locations

1250 S 18th St
Ste 202
Fernandina Beach, FL 32034
Phone (904) 202-2000

1747 Baptist Clay Dr
Ste 250
Fleming Isle, FL 32003
Phone (904) 516-1000

800 Prudential Dr
Ste 713
Jacksonville, FL 32207
Phone (813) 240-2610

820 Prudential Dr
Ste 713
Jacksonville, FL 32207
Phone (800) 936-5996

Organizations & group practices 4

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 7

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": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211328000000",
    "number": "1811953524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9824 SCOTT MILL RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322575845",
            "telephone_number": "904-737-2314",
            "fax_number": "904-236-6581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 PRUDENTIAL DR",
            "address_2": "SUITE 713",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078202",
            "telephone_number": "904-396-5682",
            "fax_number": "904-346-0864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUSKO",
        "first_name": "MICHAEL",
        "middle_name": "WALTER",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2008-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "OS3713",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "82132",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000762748C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "069703600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.