Jackie Luthardt, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

81595-20 Issued in WI

Practice address

420 E Division St
Fond Du Lac, WI 54935-4560

Phone

(920) 926-8450

NPI assigned

May 2, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Obstetrics/Gynecology

Education

Michigan State University College of Human Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Agnesian Healthcare IncGroup PAC ID 1658289624, 392 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SSM Health St Agnes Hospital-Fond Du Lac Hospital, Fond Du Lac, WI, CCN 520088

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jluthardt397337@direct-ehr-ssmhc.com

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.

• Agnesian Healthcare, Inc

  • General Acute Care Hospital
  • Fond Du Lac, WI
  • NPI 1346228541
  Medicare reassignment Care Compare group NPD
• Agnesian Healthcare Inc

  • Community/Retail Pharmacy
  • Waupun, WI
  • NPI 1366417917
  NPD
• Agnesian Healthcare Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fond Du Lac, WI
  • NPI 1841320884
  NPD

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

• Agnesian Healthcare, Inc

  • General Acute Care Hospital
  • Fond Du Lac, WI
  • NPI 1346228541
  Care Compare affiliation

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

{
    "created_epoch": "1619913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753920000000",
    "number": "1679156202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "749 UNIVERSITY ROW STE 200",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537051465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 E DIVISION ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354560",
            "telephone_number": "920-926-8450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Highland Ave",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537920001",
            "country_code": "US",
            "telephone_number": "608-263-6400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUTHARDT",
        "first_name": "JACKIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-02",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "81595-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas J Luetzow, M.D.
• Lumos
• Jack Lund
• Sheri Lund
• Breanne M Lundt
• Lutheran Social Services of Upper Michigan
• Luxottica Retail North America Inc
• Michael Anthony Lynch, PSY.D.
• Elizabeth Anne Machi, DDS
• Kassianna G Madison

• Obstetrics & Gynecology Physician in Fond Du Lac, WI
• Providers in Fond Du Lac, WI by specialty
• Obstetrics & Gynecology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; 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.