Individual provider Active NPI

Lori K Krause, PA

  • Physician Assistant
  • Sioux City, IA
National Provider Identifier
1104877281
Registry record updated Jun 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001290 Issued in IA
Practice address
1021 Nebraska Street
Sioux City, IA 51104
Phone
(712) 252-2477
Fax
(712) 252-5516
NPI assigned
May 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1973 NE
Physician Assistant 363A00000X 001290 IA Primary

Addresses

Primary practice location

1021 Nebraska Street
Sioux City, IA 51104

Mailing address

1021 Nebraska Street
PO Box 5410
Sioux City, IA 51102
Phone (712) 252-2477

Other practice location 1

3410 Futures Dr
South Sioux City, NE 68776-3917
Phone (402) 412-7242

Other identifiers 1

IdentifierTypeStateIssuer
0092080MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1104877281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 NEBRASKA STREET",
            "address_2": "PO BOX 5410",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "51102",
            "telephone_number": "712-252-2477",
            "fax_number": "712-252-5516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 NEBRASKA STREET",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "51104",
            "telephone_number": "712-252-2477",
            "fax_number": "712-252-5516"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3410 Futures Dr",
            "address_purpose": "LOCATION",
            "city": "South Sioux City",
            "state": "NE",
            "postal_code": "687763917",
            "country_code": "US",
            "telephone_number": "402-412-7242",
            "fax_number": "712-252-5920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRAUSE",
        "first_name": "LORI",
        "middle_name": "K",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-13",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1973",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "001290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0092080",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.