Individual provider Active NPI

Laura L Wavra, NP

  • Family Nurse Practitioner
  • West Lafayette, IN
National Provider Identifier
1003876434
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71001832A Issued in IN
Practice address
124 Sagamore Pkwy W
West Lafayette, IN 47906-1569
Phone
(765) 463-6722
Fax
(765) 463-0905
NPI assigned
Mar 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71001832A IN Primary
Nurse Practitioner 363L00000X 71001832A IN

Addresses

Primary practice location

124 Sagamore Pkwy W
West Lafayette, IN 47906-1569

Mailing address

124 Sagamore Pkwy W
West Lafayette, IN 47906-1569
Phone (765) 463-6722

Other identifiers 1

IdentifierTypeStateIssuer
200506050MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050301000042 IN Practitioner - Nurse Practitioner 8628021839 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Randall Dermatology, PCGroup PAC ID 3678675329, 10 clinicians

Practice addresses (Care Compare)

1351 S Jackson St
Frankfort, IN 46041-3314
Phone (765) 659-3330

201 N Union St
Westfield, IN 46074-9405
Phone (317) 804-9426

Merit-based Incentive Payment System (MIPS)

Final score
88.65 of 100Reported as group
Quality
91.4
Improvement activities
40
Cost
73.63

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71001832AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Randall Dermatology, PC Nurse Practitioner CurrentSince Oct 29, 2010 Accepting new patients
Albert C. Lee, M.D., P.C. Past Accepting new patients
Unity Healthcare LLC Past Accepting new patients

Locations

1351 S Jackson St
Frankfort, IN 46041
Phone (765) 452-8602

620 S Berkley Rd
Kokomo, IN 46901
Phone (317) 457-8291

1201 N McKinley Ave
Rensselaer, IN 47978
Phone (219) 866-7124

124 Sagamore Pkwy W
West Lafayette, IN 47906
Phone (765) 463-6722

201 N Union St
Westfield, IN 46074
Phone (317) 776-0760

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1003876434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 SAGAMORE PKWY W",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479061569",
            "telephone_number": "765-463-6722",
            "fax_number": "765-463-0905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 SAGAMORE PKWY W",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479061569",
            "telephone_number": "765-463-6722",
            "fax_number": "765-463-0905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAVRA",
        "first_name": "LAURA",
        "middle_name": "L",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-28",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71001832A",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71001832A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200506050",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Lafayette, IN

Sources for this page

Verify at the official NPI Registry.