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LUCAS TIDWELL MD
NPI 1942837588
Surgery in Southfield, MI

Active since March 24, 2020PECOS Enrolled
22250 PROVIDENCE DR STE 206, SOUTHFIELD, MI 48075(248) 662-4333 Get Directions Write a Review

NPPES record last updated: July 8, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 8, 2025, Mar 24, 2020 (2 updates tracked since 2020).

About Lucas Tidwell Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LUCAS TIDWELL MD (NPI 1942837588) is an individual surgery provider in Southfield, Michigan, licensed in Michigan (4301514131) and active in the NPI registry since March 2020. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1942837588
Entity TypeIndividualMale
Primary Taxonomy208600000X
Provider Legal NameLUCAS TIDWELLCredential: MD
Location Address22250 PROVIDENCE DR STE 206Southfield, MI 48075-6210
Mailing Address22250 Providence Dr Ste 206Southfield, MI 48075-6210 · (248) 662-4333
Phone(248) 662-4333
Sole ProprietorNo
Enumeration DateMarch 24, 2020
Last NPPES UpdateJuly 8, 20252 updates tracked since enumeration
NPPES CertifiedJuly 8, 2025
✔ NPI 1942837588 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
License✔ Licensed in MI · 4301514131
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
22250 PROVIDENCE DR STE 206, Southfield, MI 48075
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lucas Tidwell Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48075 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$90.76 typical visit price
range $58.04 – $177.36
Typical copayment $22.69 (range $14.51 – $44.34)
Most-billed visit code 99203
Established Patient
$72.38 typical visit price
range $18.32 – $143.49
Typical copayment $18.09 (range $4.58 – $35.87)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MICHAEL WON KYU LEE MD
Thoracic Surgery (Cardiothoracic Vascular Surgery)
22250 PROVIDENCE DR STE 206
SOUTHFIELD, MI 48075
Oakland County (248) 709-4430
SUBIN PUNNEN MD
Surgery
22250 PROVIDENCE DR STE 206
SOUTHFIELD, MI 48075
Oakland County (248) 662-4333
ALYSSA JOY STROUD MD
Surgery
22250 PROVIDENCE DR STE 206
SOUTHFIELD, MI 48075
Oakland County (248) 662-4333
CARDIOTHORACIC SURGERY SPECIALISTS PLLC
Thoracic Surgery (Cardiothoracic Vascular Surgery)
22250 PROVIDENCE DR STE 206
SOUTHFIELD, MI 48075
Oakland County (248) 621-9777

Frequently 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 Lucas Tidwell's NPI number?

The NPI number for Lucas Tidwell is 1942837588. It was assigned to this individual provider in the NPPES registry on March 24, 2020.

Where is Lucas Tidwell located?

Lucas Tidwell practices at 22250 Providence Dr Ste 206, Southfield, MI 48075. The listed phone number is (248) 662-4333.

What is Lucas Tidwell's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Lucas Tidwell enrolled in Medicare?

Yes. Lucas Tidwell is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Lucas Tidwell was last updated on July 8, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.