DR. LUCKY LUSTERIO (D.O.) – General Practice Physician, NPI 1609149681

General Practice Physician

DR. LUCKY LUSTERIO (D.O.) is a healthcare provider. based in Randolph afb, Texas. specializing in PREVENTIVE MEDICINE. They hold the professional credentials D.O.. They hold a License No. 02004069A (IN). The NPI Number for DR. LUCKY LUSTERIO (D.O.) is 1609149681

Main info

Male

15 Years Of Experience

Accepts Medicare Assignment

Name

DR. LUCKY LUSTERIO (D.O.)

NPI

1609149681

Phone

(210) 652-0201

Address

221 3RD ST. W

Enumeration Date

21 February 2012

Last Update Date

10 October 2025

Doctor Profile

Medical School Name

OTHER

Secondary Phone

2102267767

Graduation Year

2011 (15 years ago)

PAC ID

5395981740

Group Practice PAC ID

9739260019

Professional Enrollment ID

I20241216001955

Address ID

TX782192337SA3453XEXPY501

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience57

Completeness85

Years active:14State licenses:1Digital endpointsOther names

96 PREVENTIVE MEDICINE in TX

Provider Addresses for DR. LUCKY LUSTERIO (D.O.)

221 3RD ST. W
RANDOLPH AFB, TX 78150
Phone: (210) 652-0201
Type: Mailing
1100 WILFORD HALL LOOP
JBSA LACKLAND, TX 782365638
Phone: (210) 292-3536
Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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: 2024-12-16

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

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
I20241216001955	I	Preventive Medicine	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.

Verify on CMS Revalidation Lookup Tool

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 78150)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 9739260019View full group profile

Name	Specialty	State
JOHN HAYES (MD)	-	TN
MOBASHAR AHMAD (M.D.)	-	VA
Unknown Individual	-	IN
JASON G CARTER (MD)	A N E S T H E S I O L O G Y	IN
CLIFFORD R SHAW (MD)	-	TN
DAVID LYMAN (M.D.)	-	NM
ANTHONY KOHLENBERG (M.D.)	-	WI
JULIANNA RAE HAAS (PA-C)	Physician Assistant	PA
MS. DEBRA LEE YOCKEY (PA-C)	-	OH
JASON RUSK (PA-C)	Physician Assistant	NV

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Frequently asked questions

What is the standard ID for DR. LUCKY LUSTERIO (D.O.) in the U.S.?

In the U.S., DR. LUCKY LUSTERIO (D.O.) is identified by NPI 1609149681.

Quick check: is DR. LUCKY LUSTERIO (D.O.) active?

Public NPPES data shows DR. LUCKY LUSTERIO (D.O.) with an active NPI status right now.

What does the directory say DR. LUCKY LUSTERIO (D.O.) does?

Insurance directories may phrase it differently, but here DR. LUCKY LUSTERIO (D.O.) maps to General Practice Physician. Clinical services aligned with this taxonomy classification.

Is DR. LUCKY LUSTERIO (D.O.) tied to Randolph Afb, Texas?

If you are local to Randolph Afb, Texas, DR. LUCKY LUSTERIO (D.O.) may be relevant to your search.

Can I verify credentials using only NPI?

NPI confirms identity in the directory; licensure and board certification require separate checks.