Analise Kathryn Lucas, PA-C
Individual provider Active NPI Physician Assistant · Peridot, AZ
NPI 1922068808 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1922068808
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 2510 (AZ)
- Practice address
- 103 Medicine Way Road
Peridot, AZ 85542 - Phone
- (928) 475-1340
- Fax
- (928) 475-7370
- NPI assigned
- Mar 24, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- San Carlos Apache Healthcare Corporation
Practice addresses (Care Compare)
103 Medicine Way Rd
Peridot, AZ 85542-0787
Phone (928) 475-1400
P O Box
Suite 787
Peridot, AZ 85542-0787
PO Box
Suite 787
Peridot, AZ 85542-0787
Hospital & facility affiliations
- San Carlos Apache Healthcare Corporation
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AZ, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071101000478 | AZ | Practitioner - Physician Assistant | 6800983214 | |
| I20130725000073 | TX | Practitioner - Physician Assistant | 6800983214 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2510 | AZ | MD | Physician Assistant |
| 3811 | CO | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| San Carlos Apache Healthcare Corporation | Current |
Accepting new patients |
Locations
103 Medicine Way Rd
Peridot, AZ 85542
Phone (928) 475-1200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 3811 | CO | |
| Physician Assistant | 363A00000X | 2510 | AZ | Yes |
Addresses
Primary practice location
103 Medicine Way Road
Peridot, AZ 85542
Mailing address
P. O. Box 787 - 0787
Peridot, AZ 85542
Phone (928) 475-1340
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 624959 | Medicaid | AZ |
Other names
- Kathryn J Gradin
Other providers in Peridot, AZ
- Leanna H Le
- Tracy Le
- Sandra Maria Leier
- Bing Li
- Sai Low
- Heidi Sieglinde Lucas
- Nathan Marc Lunt
- Jessica M Madrid-Warden
- Krysta Maltos
- Heather Alyse Markel
All providers in Peridot, AZ · Physician Assistant in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.