Individual provider Active NPI

Jessica Lucero, PA

  • Physician Assistant
  • Spokane, WA
National Provider Identifier
1982217089
Registry record updated Oct 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA61324167 Issued in WA
Practice address
1401 E Trent Ave # 200
Spokane, WA 99202-2902
Phone
(509) 747-3147
NPI assigned
Aug 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X PA61324167 WA Primary

Addresses

Primary practice location

1401 E Trent Ave # 200
Spokane, WA 99202-2902

Mailing address

1401 E Trent Ave # 200
Spokane, WA 99202-2902

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221011002818 WA Practitioner - Physician Assistant 1153797477 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spokane Urology PLLCGroup PAC ID 5991603367, 24 clinicians

Practice addresses (Care Compare)

1401 E Trent Ave
Suite 200
Spokane, WA 99202-2902
Phone (509) 747-3147

5633 N Lidgerwood St
Spokane, WA 99208-1224
Phone (509) 363-7554

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA61324167WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Spokane Urology PLLC CurrentSince Nov 21, 2022 Accepting new patients
Spokane Urology PLLC CurrentSince Nov 21, 2022 Accepting new patients

Locations

1401 E Trent Ave
#200
Spokane, WA 99202
Phone (509) 747-3147

1401 E Trent Ave
Ste 200
Spokane, WA 99202
Phone (509) 747-3147

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1598572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1982217089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 E TRENT AVE # 200",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992022902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 E TRENT AVE # 200",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992022902",
            "telephone_number": "509-747-3147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCERO",
        "first_name": "JESSICA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-28",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61324167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.