NPIMap

Individual provider Active NPI

Lisa Beth Wurnig-Johnson, PA-C

  • Surgical Physician Assistant
  • Aberdeen, SD
National Provider Identifier
1407945918
Registry record updated Aug 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
0480 Issued in SD
Practice address
815 1St Ave SE
Aberdeen, SD 57401-4602
Phone
(605) 622-5123
Fax
(605) 622-5906
NPI assigned
Oct 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 0480 SD Primary

Addresses

Primary practice location

815 1St Ave SE
Aberdeen, SD 57401-4602

Mailing address

PO Box 1460
Aberdeen, SD 57402-1460
Phone (605) 622-2876

Other names 1

  • Lisa Kautz Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
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
I20120312000297 SD Practitioner - Physician Assistant 7416116413 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera St LukesGroup PAC ID 6406764927, 164 clinicians

Practice addresses (Care Compare)

305 S State St
Aberdeen, SD 57401-4527
Phone (605) 622-5100

701 8TH Ave NW
Aberdeen, SD 57401-1865

8 E US Hwy 12
Groton, SD 57445-2176
Phone (605) 397-4242

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0480SDMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Network, Inc. CurrentSince Jan 10, 2012 Accepting new patients
Monument Health Network, Inc. CurrentSince Jan 10, 2012 Accepting new patients
Avera St. Lukes CurrentSince Apr 14, 2014 Accepting new patients
Avera St. Luke'S CurrentSince Apr 14, 2014 Accepting new patients

Locations

815 1st Ave SE
Aberdeen, SD 57401
Phone (605) 622-2570

305 S State St
Aberdeen, SD 57401
Phone (605) 229-3000

1440 N Main St
Spearfish, SD 57783
Phone (605) 644-4000

2140 Junction Ave
Sturgis, SD 57785
Phone (605) 720-2400

Interoperability endpoints

  • Direct secure messaging: lisa.wurnigjohnson@avera.sdhealthlink.net

Organizations & group practices 5

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 9

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470182400000",
    "number": "1407945918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1460",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574021460",
            "telephone_number": "605-622-2876",
            "fax_number": "605-622-2804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 1ST AVE SE",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574014602",
            "telephone_number": "605-622-5123",
            "fax_number": "605-622-5906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WURNIG-JOHNSON",
        "first_name": "LISA",
        "middle_name": "BETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2016-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SD",
            "license": "0480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "KAUTZ",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Aberdeen, SD

Sources for this page

Verify at the official NPI Registry.