Active NPI
Samuel Elijah Lupkes, OD
- Optometrist
- Faribault, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3832
- Practice address
- 300 Western Ave NW Ste 100 1/2
Faribault, MN 55021-4528 - Phone
- (916) 747-0029
- NPI assigned
- Nov 14, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3832 | MN | Primary |
Addresses
Primary practice location
300 Western Ave NW Ste 100 1/2
Faribault, MN 55021-4528
Mailing address
601 1St Ave NE Apt 327
Faribault, MN 55021-2904
Phone (916) 747-0029
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Southern College of Optometry, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1004 18TH Ave NW
Suite D
Austin, MN 55912-1993
Phone (507) 437-8228
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shoptikal LLC | Optometrist | Current | Accepting new patients |
| Shoptikal LLC | Optometrist | Current | Accepting new patients |
| Shoptikal LLC | Optometrist | Past | Accepting new patients |
Locations
1004 18th Ave NW
Ste D
Austin, MN 55912
Phone (507) 437-8228
300 Western Ave NW
Ste 100
Faribault, MN 55021
Phone (507) 330-8168
501 Highway 10 S
Saint Cloud, MN 56304
Phone (320) 253-4695
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668384000000",
"number": "1689382020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 1ST AVE NE APT 327",
"city": "FARIBAULT",
"state": "MN",
"postal_code": "550212904",
"telephone_number": "916-747-0029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 WESTERN AVE NW STE 100 1/2",
"city": "FARIBAULT",
"state": "MN",
"postal_code": "550214528",
"telephone_number": "916-747-0029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUPKES",
"first_name": "SAMUEL",
"middle_name": "ELIJAH",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-11-14",
"last_updated": "2022-11-14",
"certification_date": "2022-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "3832",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Faribault, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; 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.