Jennifer Ann Lundgren, PMHNP
Individual provider Active NPI Psychiatry Physician · Shenandoah, IA
NPI 1104515311 · NPPES record last updated May 18, 2023
Key facts
- NPI
- 1104515311
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- G174269 (IA)
- Practice address
- 300 Pershing Ave
Shenandoah, IA 51601-2355 - Phone
- (712) 246-7285
- NPI assigned
- May 3, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Shenandoah Medical Center
Practice addresses (Care Compare)
1 Jack Foster Dr
Shenandoah, IA 51601-4586
Phone (712) 246-7240
Hospital & facility affiliations
- Shenandoah Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230628000158 | IA | Practitioner - Nurse Practitioner | 1052779782 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 155203 | IA | MD | General Practice Registered Nurse |
| G174269 | IA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shenandoah Medical Center | Current | Accepting new patients | |
| Shenandoah Medical Center | Current |
Accepting new patients | |
| Shenandoah Medical Center | Current | Accepting new patients | |
| Shenandoah Medical Center | Current |
Accepting new patients |
Locations
300 Pershing Ave
Shenandoah, IA 51601
Phone (712) 246-1230
1 Jack Foster Dr
Shenandoah, IA 51601
Phone (712) 246-7240
Interoperability endpoints
- jenniferlundgren@shenmed.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | 155203 | IA | |
| Psychiatry Physician | 2084P0800X | G174269 | IA | Yes |
Addresses
Primary practice location
300 Pershing Ave
Shenandoah, IA 51601-2355
Mailing address
300 Pershing Ave
Shenandoah, IA 51601-2355
Phone (712) 246-7285
Other providers in Shenandoah, IA
- Kelly Lynn Kline
- Logan J Kopf
- Angela Sue Ledford
- Darci Lewis
- Holly Maureen Logan
- David Lutz
- Angela Dawn Mace
- Martee R Macleod-Kozal
- Carin Renee Mason
- Jeffrey P McCoy
All providers in Shenandoah, IA · Psychiatry Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.