NPIMap

Individual provider Active NPI

Mary Lundgren, D.O.

  • Orthopaedic Surgery Physician
  • Pueblo, CO
National Provider Identifier
1386061844
Registry record updated Mar 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
67638 Issued in CO
Practice address
3530 E Spaulding Ave
Pueblo, CO 81008-2209
Phone
(719) 296-9000
Fax
(719) 296-9001
NPI assigned
Mar 23, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery of the Spine Physician 207XS0117X 73026-21 WI
Orthopaedic Surgery Physician 207X00000X 67638 CO Primary

Addresses

Primary practice location

3530 E Spaulding Ave
Pueblo, CO 81008-2209

Mailing address

3530 E Spaulding Ave
Pueblo, CO 81008-2209
Phone (719) 296-9000

Other practice location 1

3033 W Layton Ave
Greenfield, WI 53221-2628
Phone (414) 647-0033

Other practice location 2

3601 W 13 Mile Rd
Royal Oak, MI 48073
Phone (248) 898-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220405003133 CO Practitioner - Orthopedic Surgery 8224323670 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Midwestern University, Chicago College of Osteopathic Med, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kenneth D Danylchuk, MD, PCGroup PAC ID 0042204109, 4 clinicians

Practice addresses (Care Compare)

3530 E Spaulding Ave
Pueblo, CO 81008-2209
Phone (719) 296-9000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion13
Laminectomy or laminotomy (partial removal of spine bones)22

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
67638COMDOrthopaedic Surgery Physician
73026-21WIMDOrthopaedic Surgery of the Spine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kenneth D Danylchuk, MD, PC Orthopaedic Surgery CurrentSince May 15, 2022 Accepting new patients

Locations

3530 E Spaulding Ave
Pueblo, CO 81008
Phone (719) 296-0077

Organizations & group practices 1

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.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1395532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648425600000",
    "number": "1386061844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3530 E SPAULDING AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082209",
            "telephone_number": "719-296-9000",
            "fax_number": "719-296-9001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3530 E SPAULDING AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082209",
            "telephone_number": "719-296-9000",
            "fax_number": "719-296-9001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3033 W Layton Ave",
            "address_purpose": "LOCATION",
            "city": "Greenfield",
            "state": "WI",
            "postal_code": "532212628",
            "country_code": "US",
            "telephone_number": "414-647-0033",
            "fax_number": "414-817-3928",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3601 W 13 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Royal Oak",
            "state": "MI",
            "postal_code": "48073",
            "country_code": "US",
            "telephone_number": "248-898-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUNDGREN",
        "first_name": "MARY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-23",
        "last_updated": "2022-03-28",
        "certification_date": "2021-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "WI",
            "license": "73026-21",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CO",
            "license": "67638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.