Individual provider Active NPI

Ericka C Luckel, P.A.

  • Physician Assistant
  • Bend, OR
National Provider Identifier
1851398978
Registry record updated Aug 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA00979 Issued in OR
Practice address
2200 NE Neff Rd
Suite 200
Bend, OR 97701-4281
Phone
(541) 382-3344
Fax
(541) 382-1681
NPI assigned
Jul 5, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2017

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 PA00979 OR Primary

Addresses

Primary practice location

2200 NE Neff Rd
Suite 200
Bend, OR 97701-4281

Mailing address

2041 NE Williamson CT
Ste B
Bend, OR 97701-3941
Phone (541) 382-3344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20050301000925 OR Practitioner - Physician Assistant 9537112552 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peters Dermatology CenterGroup PAC ID 9739487208, 5 clinicians

Practice addresses (Care Compare)

2353 NE Conners Ave
Bend, OR 97701-6068
Phone (541) 323-7546

Hospital & facility affiliations

  • St Charles Medical Center - Bend Hospital, Bend, OR, CCN 380047

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA00979ORMDPhysician Assistant

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.

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": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503014400000",
    "number": "1851398978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 NE WILLIAMSON CT",
            "address_2": "STE B",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977013941",
            "telephone_number": "541-382-3344",
            "fax_number": "541-382-1681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 NE NEFF RD",
            "address_2": "SUITE 200",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014281",
            "telephone_number": "541-382-3344",
            "fax_number": "541-382-1681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCKEL",
        "first_name": "ERICKA",
        "middle_name": "C",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-05",
        "last_updated": "2017-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA00979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.