Individual provider Active NPI

Jonathan Tyler Laack, D.O.

  • Emergency Medicine Physician
  • Weston, WI
National Provider Identifier
1487090072
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
67074 Issued in WI
Practice address
3400 Ministry Pkwy
Weston, WI 54476-5220
Phone
(715) 393-3000
NPI assigned
May 22, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 5101020493 MI
Emergency Medicine Physician 207P00000X 67074 WI Primary

Addresses

Primary practice location

3400 Ministry Pkwy
Weston, WI 54476-5220

Mailing address

3400 Ministry Pkwy
Weston, WI 54476-5220
Phone (715) 393-3000

Other practice location 1

1234 Napier Ave
Saint Joseph, MI 49085-2112
Phone (269) 982-4941

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@marshfieldclinichealthsystem.cernerdirect.com Direct

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170711001590 WI Practitioner - Emergency Medicine 7911209879 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
80.58 of 100Reported as group
Quality
55.5
Promoting interoperability
100
Improvement activities
40
Cost
71.46

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
67074WIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marshfield Clinic Inc CurrentSince Jun 30, 2020 Accepting new patients
Aspirus Merrill Hospital & Clinics, Inc. CurrentSince Jul 1, 2017 Accepting new patients
Aspirus Merrill Hospital & Clinics, Inc. CurrentSince Jul 1, 2017 Accepting new patients
MCHS Hospitals Inc Emergency Medicine CurrentSince Jun 30, 2020 Accepting new patients
Aspirus Stevens Point Hospital & Clinics, Inc. CurrentSince Jul 1, 2017 Accepting new patients
MCHS Hospitals Inc CurrentSince Jun 30, 2020 Accepting new patients
MCHS Hospitals Inc Emergency Medicine Current Accepting new patients
Aspirus Stevens Point Hospital & Clinics, Inc. Emergency Medicine CurrentSince Jul 1, 2017 Accepting new patients
Memorial Hospital Inc Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200

1000 Starr Ave
Eau Claire, WI 54703
Phone (715) 858-4850

1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111

601 S Center Ave
Merrill, WI 54452
Phone (715) 536-5511

900 Illinois Ave
Stevens Point, WI 54481
Phone (715) 342-7500

3400 Ministry Pkwy
Weston, WI 54476
Phone (715) 393-1000

Interoperability endpoints

  • Direct secure messaging: jonathan.laack@marshfieldclinichealthsystem.cernerdirect.com
  • Direct secure messaging: him@marshfieldclinichealthsystem.cernerdirect.com

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1369180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1487090072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 MINISTRY PKWY",
            "city": "WESTON",
            "state": "WI",
            "postal_code": "544765220",
            "telephone_number": "715-393-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 MINISTRY PKWY",
            "city": "WESTON",
            "state": "WI",
            "postal_code": "544765220",
            "telephone_number": "715-393-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1234 Napier Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Joseph",
            "state": "MI",
            "postal_code": "490852112",
            "country_code": "US",
            "telephone_number": "269-982-4941",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAACK",
        "first_name": "JONATHAN",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-22",
        "last_updated": "2022-07-21",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101020493",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "67074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@marshfieldclinichealthsystem.cernerdirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3400 Ministry Pkwy",
            "city": "Weston",
            "state": "WI",
            "country_code": "US",
            "postal_code": "544765220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Weston, WI

Sources for this page

Verify at the official NPI Registry.