Active NPI
John P Lundeby, MD
- Surgery Physician
- Coeur D Alene, ID
National Provider Identifier
1720190796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- M6914
- Practice address
- 608 Northwest Blvd
Suite 301
Coeur D Alene, ID 83814-2174 - Phone
- (208) 664-4940
- Fax
- (208) 664-5345
- NPI assigned
- Aug 31, 2006
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | M6914 | ID | Primary |
Addresses
Primary practice location
608 Northwest Blvd
Suite 301
Coeur D Alene, ID 83814-2174
Mailing address
608 Northwest Blvd
Suite 301
Coeur D Alene, ID 83814-2174
Phone (208) 664-4940
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 807104000 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 27, 2018 through Feb 27, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M6914 | ID | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Palouse Surgeons, LLC | Past | Accepting new patients | |
| Laser and Vein Center PLLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Vascular Surgery Physician
- Coeur D Alene, ID
- NPI 1043322811
-
- Specialist
- Pullman, WA
- NPI 1518009562
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720190796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "608 NORTHWEST BLVD",
"address_2": "SUITE 301",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838142174",
"telephone_number": "208-664-4940",
"fax_number": "208-664-5345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "608 NORTHWEST BLVD",
"address_2": "SUITE 301",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838142174",
"telephone_number": "208-664-4940",
"fax_number": "208-664-5345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUNDEBY",
"first_name": "JOHN",
"middle_name": "P",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "ID",
"license": "M6914",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "807104000",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coeur D Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.