Active NPI
Lauren Sundick, RPA-C
- Physician Assistant
- Roseville, MN
National Provider Identifier
1316278187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 11213
- Practice address
- 1835 County Road C W
Suite 250
Roseville, MN 55113-1352 - Phone
- (651) 633-6883
- NPI assigned
- Jan 19, 2010
- Last updated
- Mar 9, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 012434-1 | NY | |
| Physician Assistant | 363A00000X | 1782 | MN | |
| Physician Assistant | 363A00000X | 11213 | MN | Primary |
Addresses
Primary practice location
1835 County Road C W
Suite 250
Roseville, MN 55113-1352
Mailing address
2 Carlson Pkwy N
Ste 240
Plymouth, MN 55447-4485
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11213 | MN | MD | Physical Therapist |
| 1782 | MN | MD | Physician Assistant |
| 012434-1 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1263859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520553600000",
"number": "1316278187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 CARLSON PKWY N",
"address_2": "STE 240",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554474485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1835 COUNTY ROAD C W",
"address_2": "SUITE 250",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551131352",
"telephone_number": "651-633-6883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUNDICK",
"first_name": "LAUREN",
"credential": "RPA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-19",
"last_updated": "2018-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "012434-1",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "1782",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "11213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.