Konnie Sue Luczak, RD, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

3245 Issued in MN

Practice address

237 Radio Dr Ste 210
Woodbury, MN 55125-4478

Phone

(612) 871-1145

Fax

(612) 870-5491

NPI assigned

Jul 31, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: konnie.luczakrd.p1@direct.mngastro.nextgenshare.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Mngi Digestive Health, P.a.

  • Gastroenterology Physician
  • Minneapolis, MN
  • NPI 1609804541

  MN

  Medicare reassignment NPD
• Centracare Clinic

  • Multi-Specialty Clinic/Center
  • St Joseph, MN
  • NPI 1134121759
  NPD (past)
• Centracare Clinic

  • Multi-Specialty Clinic/Center
  • Saint Cloud, MN
  • NPI 1225030844
  NPD (past)

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

{
    "created_epoch": "1375228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1114359205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 CENTRACARE CIR",
            "address_2": "CENTRACARE CLINIC HEALTH PLAZA",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563035000",
            "telephone_number": "320-229-4916",
            "fax_number": "320-229-5174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "237 RADIO DR STE 210",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254478",
            "telephone_number": "612-871-1145",
            "fax_number": "612-870-5491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCZAK",
        "first_name": "KONNIE",
        "middle_name": "SUE",
        "credential": "RD, LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-31",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MN",
            "license": "3245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lovely Behavioral Health Services LLC
• Alyssa Lovgren, LICSW
• Ryan Lubinsky, DDS
• Rose Luchsinger
• Marissa Lucid
• Dawn Bode Ludwig, PA
• Kimberly Kathleen Luebke, LADC
• Michael Keith Lueneburg, P.T.
• Stephanie Lynn Flater Luepke, AU.D.
• April Luera

• All providers in Woodbury, MN
• Registered Dietitian in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.