LUCAS MARTINUS SURYAKUSUMA MPAS, PA-C
NPI 1982252961
Physician Assistant in Dallas, TX

Q: What is Lucas Suryakusuma's NPI number?

The NPI number for Lucas Suryakusuma is 1982252961. It was assigned to this individual provider in the NPPES registry on September 3, 2019.

Q: What is Lucas Suryakusuma's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Lucas Suryakusuma was last updated on April 3, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years 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.

Active since September 03, 2019PECOS EnrolledAccepts Medicare Assignment

74.59/100

CMS Quality Rating

5323 HARRY HINES BLVD STOP 7200, DALLAS, TX 75390(214) 648-1701 Get Directions Write a Review

NPPES record last updated: April 3, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 3, 2020, Sep 3, 2019 (2 updates tracked since 2019).

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About Lucas Martinus Suryakusuma Mpas, Pa-c NPPES

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

LUCAS MARTINUS SURYAKUSUMA MPAS, PA-C (NPI 1982252961) is an individual physician assistant in Dallas, Texas, licensed in Texas (PA13328) and active in the NPI registry since September 2019. He is enrolled in Medicare PECOS, is affiliated with Ut Southwestern University Hospital - William P. Clements Jr., and is a graduate of Other (2019).

NPPES Registry Identity

NPI1982252961

Entity TypeIndividualMale

Primary Taxonomy363A00000X

Provider Legal NameLUCAS MARTINUS SURYAKUSUMACredential: MPAS, PA-C

Location Address5323 HARRY HINES BLVD STOP 7200Dallas, TX 75390-0001

Mailing AddressPo Box 845347Dallas, TX 75284-7208

Phone(214) 648-1701

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateSeptember 3, 2019

Last NPPES UpdateApril 3, 20202 updates tracked since enumeration

NPPES CertifiedApril 3, 2020

✔ NPI 1982252961 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in TX · PA13328

Definition

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.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

5323 HARRY HINES BLVD STOP 7200, Dallas, TX 75390

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Lucas Martinus Suryakusuma Mpas, Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7517398811

PECOS Enrollment IDI20200520000529

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.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Ut Southwestern University Hospital - William P. Clements Jr.

Acute Care Hospitals · Dallas, TX

5/5 CMS rating

OwnershipGovernment - State

CMS Certification Number450044

Location6201 Harry Hines BlvdDallas, TX 75390 · Dallas County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 75390 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

$88.19 typical visit price

range $57.18 – $172.86

Typical copayment $22.04 (range $14.29 – $43.21)

Most-billed visit code 99203

Established Patient

$71.28 typical visit price

range $18.48 – $141.20

Typical copayment $17.82 (range $4.62 – $35.30)

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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

74.59/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

56.12

Promoting Interoperability

100

Improvement Activities

Cost

59.2

Other Providers at the Same Location NPPES 20

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

DR. JOSEPH KASSAB MD, MS

Student in an Organized Health Care Education/Training Program