Individual provider Active NPI

Laura Peck

  • Surgery Physician
  • Two Rivers, WI
National Provider Identifier
1699159558
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
5101025446 Issued in MI
Practice address
5300 Memorial Dr
Two Rivers, WI 54241-3923
Phone
(920) 793-7300
NPI assigned
Jul 9, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 5101025446 MI Primary
Surgery Physician 208600000X TL.005462 CO

Addresses

Primary practice location

5300 Memorial Dr
Two Rivers, WI 54241-3923

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other practice location 1

501 E Hampden Ave
Englewood, CO 80113-2702
Phone (954) 515-6056

Other practice location 2

29000 Little Mack Ave Ste B
Saint Clair Shores, MI 48081-3018
Phone (586) 774-8811

Other practice location 3

515 E Grant St Ste 211
Macomb, IL 61455-3378
Phone (309) 833-3706

Other identifiers 1

IdentifierTypeStateIssuer
100308760MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address lpeck422553@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI, TX3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20211203000762 IL Practitioner - General Surgery 7416265269 Reassigns benefits to 1 organization
I20250310001784 WI Practitioner - General Surgery 7416265269 Reassigns benefits to 1 organization
I20250529002396 TX Practitioner - Osteopathic Manipulative Medicine 7416265269 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Nova Southeastern College of Osteo Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

5300 Memorial Dr
Two Rivers, WI 54241-3923
Phone (920) 793-7300

Hospital & facility affiliations

  • Aurora Medical Ctr Manitowoc County Hospital, Two Rivers, WI, CCN 520034
  • Aurora Medical Center Bay Area Hospital, Marinette, WI, CCN 520113

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TL.005462COMDSurgery Physician
5101025446MIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McDonough County Hospital District Current Accepting new patients
Cherokee Nation Current Accepting new patients
McDonough County Hospital District CurrentSince Nov 1, 2021 Accepting new patients
Cherokee Nation CurrentSince Mar 22, 2025 Accepting new patients
Cherokee Nation Current Accepting new patients
McDonough County Hospital District CurrentSince Nov 1, 2021 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Apr 1, 2025 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Apr 1, 2025 Accepting new patients
Cherokee Nation CurrentSince Mar 22, 2025 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

503 E Grant St
Macomb, IL 61455
Phone (309) 833-5917

515 E Grant St
Ste 211
Macomb, IL 61455
Phone (309) 833-3706

515 E Grant St
Ste 112
Macomb, IL 61455
Phone (309) 833-4104

859 E Melton Dr
Jay, OK 74346
Phone (918) 253-4271

1001 S 41st St E
#3
Muskogee, OK 74403
Phone (918) 687-0201

1020 Lenape Dr
Nowata, OK 74048
Phone (918) 273-0192

900 N Owen Walters Blvd
Salina, OK 74365
Phone (918) 434-8500

100 S Bliss Ave
Tahlequah, OK 74464
Phone (918) 458-3100

Dept 2269
Tulsa, OK 74182

27371 S 4410 Rd
Vinita, OK 74301
Phone (918) 256-4800

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

5300 Memorial Dr
Two Rivers, WI 54241
Phone (920) 793-7300

Interoperability endpoints

  • Direct secure messaging: lpeck422553@direct.myadvocateaurora.org

Organizations & group practices 10

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 4

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": "1436400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745971200000",
    "number": "1699159558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 MEMORIAL DR",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542413923",
            "telephone_number": "920-793-7300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 E Hampden Ave",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "CO",
            "postal_code": "801132702",
            "country_code": "US",
            "telephone_number": "954-515-6056",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "29000 Little Mack Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Saint Clair Shores",
            "state": "MI",
            "postal_code": "480813018",
            "country_code": "US",
            "telephone_number": "586-774-8811",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 E Grant St Ste 211",
            "address_purpose": "LOCATION",
            "city": "Macomb",
            "state": "IL",
            "postal_code": "614553378",
            "country_code": "US",
            "telephone_number": "309-833-3706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PECK",
        "first_name": "LAURA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-09",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "5101025446",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CO",
            "license": "TL.005462",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100308760",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lpeck422553@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5300 Memorial Dr",
            "city": "Two Rivers",
            "state": "WI",
            "country_code": "US",
            "postal_code": "542413923",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "5300 Memorial Dr",
            "city": "Two Rivers",
            "state": "WI",
            "country_code": "US",
            "postal_code": "542413923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Two Rivers, WI

Sources for this page

Verify at the official NPI Registry.