NPIMap

Individual provider Active NPI

Robert Lee Lycksell, MD

  • Family Medicine Physician
  • Oak Harbor, WA
National Provider Identifier
1922085901
Registry record updated Feb 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00020054 Issued in WA
Practice address
231 SE Barrington Drive
Suite 209
Oak Harbor, WA 98277
Phone
(360) 679-3161
Fax
(360) 679-1741
NPI assigned
Dec 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00020054 WA Primary

Addresses

Primary practice location

231 SE Barrington Drive
Suite 209
Oak Harbor, WA 98277

Mailing address

231 SE Barrington Drive
Suite 209
Oak Harbor, WA 98277
Phone (360) 679-3161

Other identifiers 3

IdentifierTypeStateIssuer
080037635OtherRAILROAD MEDICARE
05867OtherWABLUE CROSS/SHIELD
G001148103OtherWAMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20100719000153 WA Practitioner - Family Practice 9032214366 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Whidbey Island Public Hospital DistrictGroup PAC ID 1658280680, shared by 13 NPIs, 100 clinicians
Whidbey Medical Clinic PLLCGroup PAC ID 5890683031, 3 clinicians

Practice addresses (Care Compare)

1300 NE Goldie St
Oak Harbor, WA 98277-4832

231 SE Barrington Dr
Suite 209
Oak Harbor, WA 98277-3200
Phone (360) 679-3161

Hospital & facility affiliations

  • Eden Home Health Home health agency, Bellingham, WA, CCN 507105
  • Signature Healthcare at Home Home health agency, Burlington, WA, CCN 507100
  • Island Hospital Hospital, Anacortes, WA, CCN 500007
  • Whidbeyhealth Medical Center Hospital, Coupeville, WA, CCN 501339

Merit-based Incentive Payment System (MIPS)

Final score
31.74 of 100Reported as individual
Improvement activities
0
Cost
63.49

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00020054WAMDFamily Medicine Physician

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 9

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": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298246400000",
    "number": "1922085901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 SE BARRINGTON DRIVE",
            "address_2": "SUITE 209",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "98277",
            "telephone_number": "360-679-3161",
            "fax_number": "360-679-1741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 SE BARRINGTON DRIVE",
            "address_2": "SUITE 209",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "98277",
            "telephone_number": "360-679-3161",
            "fax_number": "360-679-1741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYCKSELL",
        "first_name": "ROBERT",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2011-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00020054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080037635",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/SHIELD",
            "identifier": "05867",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "G001148103",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Harbor, WA

Sources for this page

Verify at the official NPI Registry.