Individual provider Active NPI

Lukas Gladstone, D.O.

  • Emergency Medicine Physician
  • Amery, WI
National Provider Identifier
1679937452
Registry record updated Jul 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
71382-21 Issued in WI
Practice address
265 Griffin St E
Amery, WI 54001-1439
Phone
(715) 268-8000
NPI assigned
Apr 7, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 18, 2019

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 65729 MN
Emergency Medicine Physician 207P00000X 71382-21 WI Primary

Addresses

Primary practice location

265 Griffin St E
Amery, WI 54001-1439

Mailing address

1 Akron General Ave
Akron, OH 44307-2432
Phone (330) 344-6000

Other practice location 1

1 Akron General Ave
Akron, OH 44307-2432
Phone (330) 344-6000

Other practice location 2

927 Churchill St W
Stillwater, MN 55082-6605
Phone (651) 439-5330

Other practice location 3

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 254-2456

Other practice location 4

535 Hospital Rd
New Richmond, WI 54017-1449
Phone (715) 243-2600

Other practice location 5

405 Stageline Rd
Hudson, WI 54016-7848
Phone (715) 531-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20210820000904 MI Practitioner - Emergency Medicine 0749560431 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grand River Emergency Medical Group PLC 41 clinicians

Practice addresses (Care Compare)

200 Jefferson Ave SE
Mercy Health St. Mary'S
Grand Rapids, MI 49503-4502
Phone (616) 685-5000

Hospital & facility affiliations

  • Mercy Health Saint Mary'S Hospital, Grand Rapids, MI, CCN 230059

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
65729MNMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grand River Emergency Medical Group PLC Emergency Medicine CurrentSince Dec 1, 2022 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Sep 1, 2023 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Sep 1, 2023 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

200 Jefferson Ave SE
Grand Rapids, MI 49503
Phone (616) 685-5000

1521 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-5165

4599 Towne Centre Rd
Saginaw, MI 48604
Phone (989) 497-3000

Interoperability endpoints

  • Direct secure messaging: lgladstone2292534@direct.trinity-health.org
  • Direct secure messaging: lgladstone358015@direct.hfhs.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 and National Provider Directory roles.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1459987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563408000000",
    "number": "1679937452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 AKRON GENERAL AVE",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443072432",
            "telephone_number": "330-344-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 GRIFFIN ST E",
            "city": "AMERY",
            "state": "WI",
            "postal_code": "540011439",
            "telephone_number": "715-268-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Akron General Ave",
            "address_purpose": "LOCATION",
            "city": "Akron",
            "state": "OH",
            "postal_code": "443072432",
            "country_code": "US",
            "telephone_number": "330-344-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "927 Churchill St W",
            "address_purpose": "LOCATION",
            "city": "Stillwater",
            "state": "MN",
            "postal_code": "550826605",
            "country_code": "US",
            "telephone_number": "651-439-5330",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "640 Jackson St",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551012502",
            "country_code": "US",
            "telephone_number": "651-254-2456",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "535 Hospital Rd",
            "address_purpose": "LOCATION",
            "city": "New Richmond",
            "state": "WI",
            "postal_code": "540171449",
            "country_code": "US",
            "telephone_number": "715-243-2600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "405 Stageline Rd",
            "address_purpose": "LOCATION",
            "city": "Hudson",
            "state": "WI",
            "postal_code": "540167848",
            "country_code": "US",
            "telephone_number": "715-531-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLADSTONE",
        "first_name": "LUKAS",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-07",
        "last_updated": "2019-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "65729",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "71382-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Amery, WI

Sources for this page

Verify at the official NPI Registry.