JACOB LUSTGARTEN (PA-C) – Physician Assistant, NPI 1467869982
Physician Assistant
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
8,491 PHYSICIAN ASSISTANT in TX
Provider Addresses for JACOB LUSTGARTEN (PA-C)
PO BOX 99371
FORT WORTH, TX 761990371
Phone: (682) 885-1855
Fax: (682) 885-7337
Type: Mailing
1500 COOPER ST
FORT WORTH, TX 761042710
Phone: (682) 885-7080
Fax: (682) 885-7085
Type: Location
PO BOX 733784
DALLAS, TX 753733784
Phone: (682) 885-1855
Fax: (682) 885-1396
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $89.
Total Amount is formed as General ($89) + Research ($0) + Ownership ($0) = $89.
Last reported payment date: 2024-03-19 • Largest payer in this snapshot: Ethicon US, LLC ($89).
Total Amount
$89
General + Research + Ownership
Payments
3
Total payment records
General Amount
$89
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-03-19
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Ethicon US, LLC | $89 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2014-10-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20141029001529 | I | Physician Assistant | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 76199)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physical Therapist In Private Practice | TX | |
| Physical Therapist In Private Practice | NH | |
| Orthopedic Surgery | TX | |
| Nurse Practitioner | TX | |
| Physical Therapist In Private Practice | OK | |
| Physician Assistant | TX | |
| Orthopedic Surgery | TX | |
| Physical Therapist In Private Practice | TX | |
| Physical Therapist In Private Practice | MN | |
| P O D I A T R Y | TX |
Reviews
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