LUCKYCHARM PRIMARY CARE PLLC
NPI 1336935857
Internal Medicine in Longview, TX
About Luckycharm Primary Care Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LUCKYCHARM PRIMARY CARE PLLC (NPI 1336935857) is a healthcare organization registered as an internal medicine in Longview, Texas and active in the NPI registry since April 2025. The organization holds a CLIA Waiver certificate valid through August 23, 2028 and lists Uchenne Evans Mbaraonye, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Luckycharm Primary Care Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Luckycharm Primary Care PLLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 45D2349542
Luckycharm Primary Care · Longview, TXFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Luckycharm Primary Care PLLC's NPI number?
The NPI number for Luckycharm Primary Care PLLC is 1336935857. It was assigned to this organization in the NPPES registry on April 21, 2025.
Where is Luckycharm Primary Care PLLC located?
Luckycharm Primary Care PLLC is located at 3521 N Fourth Street, Suite 100, Longview, TX 75605. The listed phone number is (903) 488-2273.
What is Luckycharm Primary Care PLLC's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Luckycharm Primary Care PLLC enrolled in Medicare?
Yes. Luckycharm Primary Care PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Luckycharm Primary Care PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Luckycharm Primary Care PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Luckycharm Primary Care PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 45D2349542) is associated with this NPI, valid through August 23, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Luckycharm Primary Care PLLC accept?
Health plans from Blue Cross and Blue Shield of Texas list Luckycharm Primary Care PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Luckycharm Primary Care PLLC was last updated on October 7, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 26 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Luckycharm Primary Care Pllc · NPI 1336935857
Internal Medicine organization in Longview, Texas. Organization record, active in the CMS NPPES registry since April 21, 2025.
## Identity
- **NPI:** 1336935857 (Entity type: Organization)
- **Enumerated:** April 21, 2025
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Organization subpart:** No
- **Authorized official:** Uchenne Mbaraonye, OWNER
## Practice location
- **Address:** 3521 N FOURTH STREET, SUITE 100, Longview, TX 75605
- **Phone:** (903) 488-2273 · **Fax:** (773) 825-8352
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Internal Medicine) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 7, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1336935857) · Data from the CMS NPPES public registry.