NPIMap

Organization Active NPI

Gundersen Lutheran Medical Center Inc

  • Clinic/Center
  • Libertyville, IL
National Provider Identifier
1144947805
Registry record updated Oct 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
GUNDERSEN LUTHERAN MEDICAL CENTER INC
Practice address
14780 Creekside Path
Libertyville, IL 60048-1107
Phone
(608) 782-7300
NPI assigned
Oct 24, 2022
Last updated
Oct 24, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
GUNDERSEN LUTHERAN MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 24, 2022

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

Authorized official

Name
Kari B Adank
Title
VP
Phone
(608) 775-8025

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

14780 Creekside Path
Libertyville, IL 60048-1107

Mailing address

1910 South Ave
La Crosse, WI 54601-5467
Phone (608) 782-7300

Other names 1

  • Milwaukee Radiologists Ltd Illinois Site Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221121000252 IL Part B Supplier - Clinic/Group Practice 2163331414 Receives reassigned benefits from 2 practitioners
2 other NPIs on this enrollment
Practice locations: Libertyville, IL; Naperville, IL; Rockford, IL

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Gundersen Lutheran Medical Center27 organizations share this tax ID, including this one
Part of
Gundersen Lutheran Medical Center

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1666569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666569600000",
    "number": "1144947805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015467",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14780 CREEKSIDE PATH",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600481107",
            "telephone_number": "608-782-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUNDERSEN LUTHERAN MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GUNDERSEN LUTHERAN MEDICAL CENTER INC",
        "enumeration_date": "2022-10-24",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A",
        "authorized_official_last_name": "ADANK",
        "authorized_official_first_name": "KARI",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "608-775-8025"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Milwaukee Radiologists Ltd Illinois Site",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 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.