Individual provider Active NPI

Cameron Lucas, PA-C

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1861345308
Registry record updated Feb 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601013613 Issued in MI
Practice address
1095 Medical Park Dr SE
Grand Rapids, MI 49546-3685
Phone
(616) 949-7220
NPI assigned
Feb 16, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2026

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 5601013613 MI Primary

Addresses

Primary practice location

1095 Medical Park Dr SE
Grand Rapids, MI 49546-3685

Mailing address

287 Timber Creek Cir NW
Comstock Park, MI 49321-8569

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20260313001184 MI Practitioner - Physician Assistant 5698258069 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Total Extended Care Services PCGroup PAC ID 9133029127, 29 clinicians

Practice addresses (Care Compare)

18312 Middlebelt Rd
Livonia, MI 48152-5007
Phone (248) 426-9944

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5601013613MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Total Extended Care Services PC CurrentSince Feb 3, 2026 Accepting new patients

Locations

400 Jeffrey St
Cedar Springs, MI 49319
Phone (616) 696-0170

1095 Medical Park Dr SE
Grand Rapids, MI 49546
Phone (616) 588-9210

18312 Middlebelt Rd
Livonia, MI 48152
Phone (248) 426-9944

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.

NPI Registry JSON

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

{
    "created_epoch": "1771200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771200000000",
    "number": "1861345308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "287 TIMBER CREEK CIR NW",
            "city": "COMSTOCK PARK",
            "state": "MI",
            "postal_code": "493218569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 MEDICAL PARK DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463685",
            "telephone_number": "616-949-7220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCAS",
        "first_name": "CAMERON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-02-16",
        "last_updated": "2026-02-16",
        "certification_date": "2026-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601013613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.