NPIMap

Individual provider Active NPI

Lisa Sitzmann Prusak

  • Family Medicine Physician
  • Duluth, MN
National Provider Identifier
1659397420
Registry record updated Jun 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
31997 Issued in MN
Practice address
6351 E Superior St
Duluth, MN 55804-2545
Phone
(218) 249-5555
NPI assigned
Jul 14, 2006
Last updated
Jun 15, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 31997 MN Primary

Addresses

Primary practice location

6351 E Superior St
Duluth, MN 55804-2545

Mailing address

915 E 1St St
Duluth, MN 55805-2107
Phone (218) 249-5555

Other identifiers 2

IdentifierTypeStateIssuer
225090000MedicaidMN
31860000MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@slk.direct.slhduluth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20050513000086 MN Practitioner - Family Practice 9638110224 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Luke's Hospital of DuluthGroup PAC ID 7113834839, 409 clinicians

Practice addresses (Care Compare)

6351 E Superior St
Duluth, MN 55804-2545
Phone (218) 249-4500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
000MNMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke's Hospital of Duluth CurrentSince Mar 28, 2022 Accepting new patients
St. Luke's Hospital of Duluth CurrentSince Mar 28, 2022 Accepting new patients
St. Luke's Hospital of Duluth Current Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860

324 W Superior St
Ste 302
Duluth, MN 55802
Phone (218) 722-6613

402 E 2nd St
Duluth, MN 55805
Phone (218) 786-3443

6351 E Superior St
Duluth, MN 55804
Phone (218) 249-4500

915 E 1st St
Duluth, MN 55805
Phone (218) 249-5352

Interoperability endpoints

  • Direct secure messaging: him@slk.direct.slhduluth.com
  • Direct secure messaging: lprusak237545@direct.aspirus.org

Organizations & group practices 3

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.

Hospital & facility affiliations 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1659397420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 E 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052107",
            "telephone_number": "218-249-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6351 E SUPERIOR ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558042545",
            "telephone_number": "218-249-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUSAK",
        "first_name": "LISA",
        "middle_name": "SITZMANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "31997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "225090000",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31860000",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@slk.direct.slhduluth.com",
            "affiliation": "N",
            "address_1": "6351 E Superior St",
            "city": "Duluth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "558042545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.