Labutale Walawwe Rajaguru, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7735 Issued in WI

Practice address

3500 Tower Ave
Superior, WI 54880-4491

Phone

(715) 817-7100

NPI assigned

Feb 23, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Udara Rajaguru Other name

Medicare fee-for-service enrollment

Enrolled in WI

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advantage Physical Therapy and Sports Rehab, LLCGroup PAC ID 8022016336, shared by 3 NPIs, 289 clinicians

St Marys Hospital of SuperiorGroup PAC ID 8628964228, 96 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Spooner Health System Homecare Home health agency, Spooner, WI, CCN 527195
• St Marys Hospital Superior Hospital, Superior, WI, CCN 521329
• Spooner Health System Hospital, Spooner, WI, CCN 521332

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• St. Mary's Hospital of Superior

  dba Essentia Health St. Mary's Hospital Superior

  • Critical Access Hospital
  • Superior, WI
  • NPI 1083657886
  Medicare reassignment Care Compare group
• St. Mary's Duluth Clinic Health System

  • Clinical Medical Laboratory
  • Superior, WI
  • NPI 1205866928
  NPD
• St. Mary's Hospital of Superior

  dba Essentia Health St. Mary's-Superior Clinic

  • Critical Access Hospital Clinic/Center
  • Superior, WI
  • NPI 1588691588
  NPD

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

• Spooner Health System, Inc.

  • Home Health Agency
  • Spooner, WI
  • NPI 1043245798
  Care Compare affiliation
• Spooner Health System, Inc.

  • Critical Access Hospital
  • Spooner, WI
  • NPI 1518982628
  Care Compare affiliation
• St. Mary's Hospital of Superior

  dba Essentia Health St. Mary's Hospital Superior

  • Critical Access Hospital
  • Superior, WI
  • NPI 1083657886
  Care Compare affiliation
• St. Mary's Hospital of Superior

  dba Essentia Health St. Mary's-Superior Clinic

  • Critical Access Hospital Clinic/Center
  • Superior, WI
  • NPI 1588691588
  Care Compare affiliation

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

{
    "created_epoch": "1708646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708646400000",
    "number": "1346006772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 TOWER AVE",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548804491",
            "telephone_number": "715-817-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAJAGURU",
        "first_name": "LABUTALE WALAWWE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-23",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14754",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "7735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "UDARA",
            "last_name": "RAJAGURU",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Professional Portable Radiologic Services, Inc. (Professional Portable X-ray, Inc.)
• Alyson Marie Strand Prouty, LPN
• Aaron D Pust, MSW, LICSW
• Raymond Alan Radtke
• Karah Radue, DPT
• Heidi Rachelle Ramsdell, PT
• Gina Ramsey, LISW, LICSW
• Randy Joten D.C. S.C.
• Heather P Rantala, RDH
• Chelsea Ann Rasmussen, PHARMACY TECHNICIAN

• Physician Assistant in Superior, WI
• Providers in Superior, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2024; 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.