NPIMap

Individual provider Active NPI

Lara M Powers, MD

  • Family Medicine Physician
  • Marinette, WI
National Provider Identifier
1730176140
Registry record updated Apr 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
45322020 Issued in WI
Practice address
1409 Cleveland Ave
Marinette, WI 54143-3918
Phone
(715) 732-0832
NPI assigned
Sep 30, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 45322020 WI Primary

Addresses

Primary practice location

1409 Cleveland Ave
Marinette, WI 54143-3918

Mailing address

1409 Cleveland Ave
Marinette, WI 54143-3918
Phone (920) 496-4700

Other identifiers 2

IdentifierTypeStateIssuer
34346300MedicaidWI
P00104680OtherRR MEDICARE

Other names 1

  • Lara Marie Peterson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070626000471 WI Practitioner - Family Practice 2769581156 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Clare Memorial Hospital, IncGroup PAC ID 0446211395, 62 clinicians

Practice addresses (Care Compare)

1409 Cleveland Ave
Marinette, WI 54143-3918
Phone (920) 496-4700

200 S Rosera St
Lena, WI 54139-9169
Phone (920) 829-6400

Hospital & facility affiliations

  • HSHS Home Care Wisconsin Home health agency, Green Bay, WI, CCN 527132
  • St Vincent Hospital Hospital, Green Bay, WI, CCN 520075
  • HSHS St Clare Memorial Hospital Hospital, Oconto Falls, WI, CCN 521310
  • St Marys Hospital Medical Ctr Hospital, Green Bay, WI, CCN 520097

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
45322020WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prevea Clinic, Inc. Family Medicine CurrentSince Sep 8, 2018 Accepting new patients
Prevea Clinic, Inc. Family Medicine CurrentSince Sep 8, 2018 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Family Medicine CurrentSince Sep 8, 2018 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Family Medicine CurrentSince Aug 1, 2009 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Aug 1, 2009 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Sep 8, 2018 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Past Accepting new patients

Locations

1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016

3021 Voyager Dr
Green Bay, WI 54311
Phone (920) 431-1810

1821 S Webster Ave
Green Bay, WI 54301
Phone (920) 431-1850

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

1715 Dousman St
Green Bay, WI 54303

1409 Cleveland Ave
Marinette, WI 54143
Phone (715) 732-0832

855 S Main St
Ste 1
Oconto Falls, WI 54154
Phone (920) 846-8187

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Interoperability endpoints

  • Direct secure messaging: lpowers5751@ewd.direct.hshs.org

Organizations & group practices 8

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 11

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": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333670400000",
    "number": "1730176140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 CLEVELAND AVE",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433918",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 CLEVELAND AVE",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433918",
            "telephone_number": "715-732-0832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWERS",
        "first_name": "LARA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-30",
        "last_updated": "2012-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "45322020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34346300",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00104680",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LARA",
            "last_name": "PETERSON",
            "middle_name": "MARIE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Marinette, WI

Sources for this page

Verify at the official NPI Registry.