NPIMap

Individual provider Active NPI

Patricia D. Luckeroth, M.D.

  • Surgery Physician
  • Salem, OR
National Provider Identifier
1932252970
Registry record updated Jan 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD175434 Issued in OR
Practice address
665 Winter St SE
Salem, OR 97301-3934
Phone
(503) 561-2448
NPI assigned
Jan 22, 2007
Last updated
Jan 11, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD175434 OR Primary
Surgery Physician 208600000X 225417 MA
Surgery of the Hand (Surgery) Physician 2086S0105X A116738 CA

Addresses

Primary practice location

665 Winter St SE
Salem, OR 97301-3934

Mailing address

PO Box 13129
Salem, OR 97309-1129

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20160322002540 OR Practitioner - Hand Surgery 7517136849 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hand Surgery
Education
Tufts University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Salem HealthGroup PAC ID 8628986668, 470 clinicians

Practice addresses (Care Compare)

890 Oak St SE
Salem, OR 97301-3905
Phone (503) 561-5200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.65 of 100Reported as group
Quality
86.8
Promoting interoperability
100
Improvement activities
40
Cost
86.36

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy39
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
225417MAMDSurgery Physician
A116738CAMDSurgery of the Hand (Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Salem Health CurrentSince Mar 14, 2016 Accepting new patients
Salem Health CurrentSince Mar 14, 2016 Accepting new patients

Locations

665 Winter St SE
Salem, OR 97301
Phone (503) 370-5634

875 Oak St SE
Salem, OR 97301
Phone (503) 561-5719

890 Oak St SE
Salem, OR 97301
Phone (503) 585-0830

Interoperability endpoints

  • Direct secure messaging: pluckeroth137835@direct.salemhealth.org

Organizations & group practices 2

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 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547164800000",
    "number": "1932252970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13129",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973091129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 WINTER ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013934",
            "telephone_number": "503-561-2448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCKEROTH",
        "first_name": "PATRICIA",
        "middle_name": "D.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2019-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD175434",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "225417",
            "primary": false
        },
        {
            "code": "2086S0105X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgery of the Hand",
            "state": "CA",
            "license": "A116738",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.