Madeline Hae Shin Lundgren, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

975 S Fairmont Ave
Lodi, CA 95240-5118

Phone

(209) 334-3411

NPI assigned

Jun 9, 2022

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 CA

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

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clinic Services of California Medical Group IncGroup PAC ID 7810209715, 65 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Lodi Memorial Hospital, Lodi, CA, CCN 050336

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

• Clinic Services of California Medical Group Inc

  • Emergency Medicine Physician
  • Lodi, CA
  • NPI 1578958450
  Medicare reassignment Care Compare group
• Team Physicians of California Medical Group Inc

  • Emergency Medicine Physician
  • Delano, CA
  • NPI 1447288345
  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lodi Memorial Hospital Association Inc

  dba Lodi Memorial Hospital

  • General Acute Care Hospital
  • Lodi, CA
  • NPI 1316938301
  Care Compare affiliation

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

{
    "created_epoch": "1654732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655683200000",
    "number": "1265161699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2736 RIVER COVE DR",
            "city": "RIVERBANK",
            "state": "CA",
            "postal_code": "953673319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 S FAIRMONT AVE",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405118",
            "telephone_number": "209-334-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUNDGREN",
        "first_name": "MADELINE",
        "middle_name": "HAE SHIN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-09",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mikayla Janelle Lozano
• Nia Tasha Lozano, M.D.
• Lancy Lu
• Christian Chan Lubrin, RN
• Brittany Luiz
• Hieu Minh Ly, O.D.
• Debra Lynch
• Jessica Anne Lyon
• M&M Family Counseling Services
• Thao Ma

• Physician Assistant in Lodi, CA
• Providers in Lodi, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.