Lola B Sutherland, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MN26313 Issued in MN

Practice address

16830 198TH Ave NW
Big Lake Clinic
Big Lake, MN 55309

Phone

(763) 263-7300

NPI assigned

Mar 3, 2006

Last updated

Dec 5, 2007By the provider in NPPES

Sex

Female

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

• Lola M Sutherland Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Centracare Clinic

  dba CentraCare - Big Lake Clinic

  • Multi-Specialty Clinic/Center
  • Big Lake, MN
  • NPI 1013104348
  NPD (past)

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

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196812800000",
    "number": "1417924994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 SIXTH AVE NO",
            "address_2": "CENTRA CARE CLINIC",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "56303",
            "telephone_number": "763-263-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16830 198TH AVE NW",
            "address_2": "BIG LAKE CLINIC",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "55309",
            "telephone_number": "763-263-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTHERLAND",
        "first_name": "LOLA",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-03",
        "last_updated": "2007-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "MN26313",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "26313",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LOLA",
            "last_name": "SUTHERLAND",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gregory Thomas Smock, D.C.
• Southern General Contracting
• Timothy John Stephens
• Nicole Rae Straw, MA OTR,L
• Barbro E Strom Langley
• The Gathering Assistant Living
• Sanjay Kumar Vanjarapu, DDS
• Mary Ellen Venzke
• Grant Michael Vickerman
• Erin Viegut, PT, DPT

• Family Medicine Physician in Big Lake, MN
• Providers in Big Lake, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.