Individual provider Active NPI

James W Lust, P.A.-C

  • Physician Assistant
  • Dover, DE
National Provider Identifier
1831116466
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C5-0000141 Issued in DE
Practice address
1095 S Bradford St
Dover, DE 19904-4141
Phone
(302) 678-8100
NPI assigned
Jul 17, 2006
Last updated
Oct 31, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 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 C5-0000141 DE Primary

Addresses

Primary practice location

1095 S Bradford St
Dover, DE 19904-4141

Mailing address

1095 S Bradford St
Dover, DE 19904-4141
Phone (302) 678-8100

Other practice location 1

111 Neurology Way
Milford, DE 19963-5368
Phone (302) 422-0800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
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
I20040110000172 DE Practitioner - Physician Assistant 3274433867 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C5-0000141DEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cnmri CurrentSince Jan 9, 2019 Accepting new patients

Locations

1074 S State St
Dover, DE 19901
Phone (302) 678-8100

1095 S Bradford St
Dover, DE 19904
Phone (302) 678-2000

111 Neurology Way
Milford, DE 19963
Phone (302) 422-0800

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1831116466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1095 S BRADFORD ST",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199044141",
            "telephone_number": "302-678-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 S BRADFORD ST",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199044141",
            "telephone_number": "302-678-8100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Neurology Way",
            "address_purpose": "LOCATION",
            "city": "Milford",
            "state": "DE",
            "postal_code": "199635368",
            "country_code": "US",
            "telephone_number": "302-422-0800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUST",
        "first_name": "JAMES",
        "middle_name": "W",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0000141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, DE

Sources for this page

Verify at the official NPI Registry.