LUCAS MARTINUS SURYAKUSUMA (NPI# 1982252961) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982252961 |
| Entity Type | Individual |
| Full Name | LUCAS MARTINUS SURYAKUSUMA |
| Credential | MPAS, PA-C |
| Practice Address |
5323 Harry Hines Blvd Stop 7200 Dallas TX 75390-0001 |
| Mailing Address |
Po Box 845347 Dallas TX 75284-7208 |
| Practice Telephone | 2146481701 |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2020-04-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA13328 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
5323 HARRY HINES BLVD STOP 7200 |
| City | DALLAS |
| State | TX |
| Zip Code | 75390-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801847991 | Elizabeth Anne Maher | Internal Medicine | 5323 Harry Hines Blvd Stop 7200, Dallas, TX 75390-7208 | 2006-05-13 |
| 1477166429 | Michael Simpson | Audiologist | 5323 Harry Hines Blvd Stop 7200, Dallas, TX 75390-7200 | 2020-08-28 |
| 1851900567 | Anjali Kalra | Student in an Organized Health Care Education/Training Program | 5323 Harry Hines Blvd Stop 7200, Dallas, TX 75390-9006 | 2020-07-28 |
| 1225647399 | Chinmayee K Venkatraman | Student in an Organized Health Care Education/Training Program | 5323 Harry Hines Blvd Stop 7200, Dallas, TX 75390-7200 | 2020-07-24 |
| 1811506090 | Chelsea Anasi | Student in an Organized Health Care Education/Training Program | 5323 Harry Hines Blvd Stop 7200, Dallas, TX 75390-7200 | 2020-07-23 |
| 1750990909 | Anthony Seek | Student in an Organized Health Care Education/Training Program | 5323 Harry Hines Blvd Stop 7200, Dallas, TX 75390-9006 | 2020-07-23 |
| 1740899087 | Naomi Mae Cohen | Student in an Organized Health Care Education/Training Program | 5323 Harry Hines Blvd Stop 7200, Dallas, TX 75390-9006 | 2020-07-22 |
| 1023626579 | Cameron Thomas Miller | Student in an Organized Health Care Education/Training Program | 5323 Harry Hines Blvd Stop 7200, Dallas, TX 75390-7200 | 2020-07-21 |
| 1932717337 | Ruqiya Sheikh-ali | Student in an Organized Health Care Education/Training Program | 5323 Harry Hines Blvd Stop 7200, Dallas, TX 75390-7200 | 2020-07-21 |
| 1407464811 | Tyler Douglas Anderson | Student in an Organized Health Care Education/Training Program | 5323 Harry Hines Blvd Stop 7200, Dallas, TX 75390-9003 | 2020-07-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467075655 | Richard Mark Bresler | Student in an Organized Health Care Education/Training Program | 5323 Harry Hines Blvd, Mc9159, Dallas, TX 75390 | 2020-05-21 |
| 1356970735 | Fabricio Stewan Feltrin | Student in an Organized Health Care Education/Training Program | 5323 Harry Hynes Boulevard, Dallas, TX 75390 | 2020-04-07 |
| 1477016467 | Seagal Raza Dauglas | Student in an Organized Health Care Education/Training Program | 5323 Harry Hines Mc9159, Dallas, TX 75390 | 2019-04-08 |
| 1831674340 | Adwoa Aninkorah | Nurse Practitioner | Ut Southwestern Medical Center 5151 Harry Hines Blvd, Dallas, TX 75390 | 2018-10-01 |
| 1194212712 | Christian Lobue | Clinical Neuropsychologist | 6333 Forest Park Road, 1st Floor, Bla 100, Dallas, TX 75390 | 2018-04-19 |
| 1912439720 | Linsey Lindley | Student in an Organized Health Care Education/Training Program | 5939 Harry Hines Blvd 4th Floor Suite 100, Dallas, TX 75390 | 2017-03-30 |
| 1043759418 | Alyssa Macchiaroli | Registered Nurse | 5323 Harry Hines Blvd Mail Code 8590, Dallas, TX 75390 | 2017-02-18 |
| 1609313980 | Megan Rasmussen Bollner | Physician Assistant | 5303 Harry Hines Blvd Fl 9, Dallas, TX 75390 | 2017-01-25 |
| 1518329168 | Danny Hsu Yang | Hospitalist | 6201 Harry Hines Blved, Dallas, TX 75390 | 2016-03-23 |
| 1780046532 | Omer Mirza | Hospitalist | 6201 Harry Hines Blvd Dallas, Dallas, TX 75390 | 2016-03-22 |
| Find all providers in zip 75390 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932700440 | Heather Weir | Physician Assistant | 7331 Gaston Ave Ste 180, Dallas, TX 75214-4131 | 2020-11-03 |
| 1225643562 | Yermiahu Levi Sarne | Physician Assistant | 6206 Preston Crest Ln, Dallas, TX 75230-1828 | 2020-09-14 |
| 1255945564 | Amanda Michelle Flores | Physician Assistant | 1801 Young St, Dallas, TX 75201 | 2020-09-03 |
| 1275151102 | Kelly Ashworth | Physician Assistant | 7331 Gaston Ave # 180, Dallas, TX 75214-4131 | 2020-07-07 |
| 1780201715 | Gabriela Yvonne Camacho | Physician Assistant | 7331 Gaston Ave Unit 180, Dallas, TX 75214-4131 | 2020-06-25 |
| 1346879699 | Ws Neuroassist, Pllc | Physician Assistant | 7324 Gaston Ave Ste 124-80, Dallas, TX 75214-6126 | 2020-04-07 |
| 1265065122 | Sarah Bell Stewart | Physician Assistant | 7811 Bryn Mawr Dr, Dallas, TX 75225-8217 | 2020-02-19 |
| 1093348237 | Meagan Lee Barry | Physician Assistant | 221 W Colorado Blvd Ste 431, Dallas, TX 75208-2312 | 2020-02-17 |
| 1245863554 | Melissa Ann Johnston | Physician Assistant | 4373 Boca Bay Dr, Dallas, TX 75244-7408 | 2020-02-14 |
| 1205479607 | Mj Surgical, Pllc | Physician Assistant | 1408 N Riverfront Blvd # 906, Dallas, TX 75207-3912 | 2019-10-18 |
| Find all providers in DALLAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.