Laura M Lundgren, PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2505 Issued in WI

Practice address

2105 E Enterprise Ave
Appleton, WI 54913-7862

Phone

(920) 560-1000

Fax

(920) 731-7133

NPI assigned

Sep 11, 2009

Last updated

Mar 14, 2023By 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

• Laura M Peterson Former 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, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hand to Shoulder Center of Wisconsin, LTD.Group PAC ID 6901884337, 34 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hand to Shoulder Center of Wisconsin, LTD.

  • Specialist
  • Appleton, WI
  • NPI 1760420277
  Medicare reassignment Care Compare group
• Baycare Clinic LLP

  • Emergency Medicine Physician
  • Green Bay, WI
  • NPI 1588609648
  Medicare reassignment NPD (past)
• Baycare Clinic LLP

  • Durable Medical Equipment & Medical Supplies
  • Manitowoc, WI
  • NPI 1134490758
  NPD
• Hand to Shoulder Center of Wisconsin, LTD.

  • Durable Medical Equipment & Medical Supplies
  • Chilton, WI
  • NPI 1750039657
  NPD

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

{
    "created_epoch": "1252627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1588997308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 E ENTERPRISE AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137862",
            "telephone_number": "920-560-1000",
            "fax_number": "920-731-7133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 E ENTERPRISE AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137862",
            "telephone_number": "920-560-1000",
            "fax_number": "920-731-7133"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "102 Grand Seasons Dr Ste 1",
            "address_purpose": "LOCATION",
            "city": "Waupaca",
            "state": "WI",
            "postal_code": "549818298",
            "country_code": "US",
            "telephone_number": "920-560-1000",
            "fax_number": "920-731-7133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUNDGREN",
        "first_name": "LAURA",
        "middle_name": "M",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-11",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2505",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WI",
            "license": "2505-23",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "PETERSON",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christopher William Ludden
• Lace Elly Luedke, PT PHD DPT OCS CSCS
• Nicole Katherine Luehring, FNP
• Benjamin J Luitjens, PA-C
• Boyd C Lumsden, M.D.
• Kristin K Lundine, APNP
• Paul Phillip Lundine, D.D.S.
• Suzanne Mary Luniak, RPH
• John Berton Luther, D.D.S.
• Lutheran Social Services of Wisconsin and Upper Michigan, Inc.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; 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.