Active NPI
Walter R Lucas, M.D.
- Pediatric Adolescent Medicine Physician
- Strongsville, OH
National Provider Identifier
1891881504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Adolescent Medicine Physician
- License
- 35 043762
- Practice address
- 17075 Pearl Road
Strongsville, OH 44136 - Phone
- (440) 572-0422
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | 35 043762 | OH | Primary |
Addresses
Primary practice location
17075 Pearl Road
Strongsville, OH 44136
Mailing address
17075 Pearl Road
Strongsville, OH 44136
Phone (440) 572-0422
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0414644 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35 043762 | OH | MD | Pediatric Adolescent Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891881504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17075 PEARL ROAD",
"city": "STRONGSVILLE",
"state": "OH",
"postal_code": "44136",
"telephone_number": "440-572-0422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17075 PEARL ROAD",
"city": "STRONGSVILLE",
"state": "OH",
"postal_code": "44136",
"telephone_number": "440-572-0422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCAS",
"first_name": "WALTER",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "OH",
"license": "35 043762",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0414644",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Strongsville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.