NPIMap

Individual provider Active NPI

Pavan R Luckoor, MD

  • Internal Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1902282692
Registry record updated Jan 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
19651 Issued in NV
Practice address
3041 E Flamingo Rd Ste a
Las Vegas, NV 89121-7447
Phone
(562) 677-2414
Fax
(562) 677-4479
NPI assigned
Aug 4, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 19651 NV Primary

Addresses

Primary practice location

3041 E Flamingo Rd Ste a
Las Vegas, NV 89121-7447

Mailing address

3041 E Flamingo Rd
Ste a
Las Vegas, NV 89121-7447
Phone (702) 436-0835

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20200428000214 NV Practitioner - Internal MedicinePractitioner - Hospitalist 6204187594 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Reliant Physicians Kumar PLLCGroup PAC ID 3577893965, 37 clinicians

Practice addresses (Care Compare)

6090 S Fort Apache Rd
Suite 140
Las Vegas, NV 89148-5618
Phone (702) 202-0534

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19651NVMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Reliant Physicians (Kumar) PLLC Internal Medicine CurrentSince Jun 1, 2023 Accepting new patients
Lychee Holdings, LLC Past Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients
Pam Specialty Hospital of Las Vegas LLC Past Accepting new patients
Physicians Medical Center Kaufman, LTD Past Accepting new patients
Harlem Hospital Past Accepting new patients
Procare Hospice of Nevada, LLC Internal Medicine Past Accepting new patients

Locations

1180 N Town Center Dr
Ste 100
Las Vegas, NV 89144
Phone (702) 202-2060

1140 N Town Center Dr
Ste 100
Las Vegas, NV 89144
Phone (702) 202-2060

6090 S Fort Apache Rd
Ste 140
Las Vegas, NV 89148
Phone (702) 202-0534

Interoperability endpoints

  • Direct secure messaging: pavan.luckoor.p3@direct.caremorewest.nextgenshare.com

Organizations & group practices 7

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.

Hospital & facility affiliations 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1438646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611878400000",
    "number": "1902282692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3041 E FLAMINGO RD",
            "address_2": "STE A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891217447",
            "telephone_number": "702-436-0835",
            "fax_number": "702-435-6212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3041 E FLAMINGO RD STE A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891217447",
            "telephone_number": "562-677-2414",
            "fax_number": "562-677-4479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCKOOR",
        "first_name": "PAVAN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-04",
        "last_updated": "2021-01-29",
        "certification_date": "2021-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "19651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.