Jack Lansing, PA-C
Individual provider Active NPI Physician Assistant · Duluth, MN
NPI 1750126108 · NPPES record last updated Jul 25, 2024
Key facts
- NPI
- 1750126108
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 14994 (MN)
- Practice address
- 1000 E 1St St Ste LL
Duluth, MN 55805-2297 - Phone
- (218) 249-6230
- NPI assigned
- Jun 27, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 12
Hospital & facility affiliations 40
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St. Luke'S Hospital of Duluth
Practice addresses (Care Compare)
1000 E 1St St
Duluth, MN 55805-2297
1011 E 1St St
Duluth, MN 55805-2242
Phone (218) 249-7000
1015 E 1St St
Duluth, MN 55805-2242
Phone (218) 249-7860
109 N 28TH St E
Superior, WI 54880-6548
Phone (715) 395-3900
1615 Maple LN
Ashland, WI 54806-3610
Phone (715) 685-5500
2201 Lake Shore Dr E
Ashland, WI 54806-2331
Phone (715) 685-6600
512 Skyline Blvd
Cloquet, MN 55720-3787
Phone (218) 879-4641
8373 Unity Dr
Virginia, MN 55792-4005
Phone (218) 748-7480
Hospital & facility affiliations
- St Lukes Hospital
- Community Memorial Hospital
- Aspirus Lake View Hospital
- Aspirus Wausau Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN, WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240807002769 | MN | Practitioner - Physician Assistant | 1254878267 | Reassigns benefits to 1 organization |
| I20250909001347 | WI | Practitioner - Physician Assistant | 1254878267 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14994 | MN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Luke'S Hospital of Duluth | Current |
Accepting new patients | |
| St. Luke'S Hospital of Duluth | Current |
Accepting new patients | |
| St. Luke'S Hospital of Duluth | Current |
Accepting new patients |
Locations
29980 Network Pl
Chicago, IL 60673
1000 E 1st St
Ste Ll
Duluth, MN 55805
Phone (218) 249-4700
915 E 1st St
Duluth, MN 55805
Phone (218) 249-5352
1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860
1615 Maple Ln
Ashland, WI 54806
Phone (715) 682-4563
109 N 28th St E
Superior, WI 54880
Phone (715) 395-3900
Interoperability endpoints
- jlansing350405@direct.aspirus.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 14994 | MN | Yes |
Addresses
Primary practice location
1000 E 1St St Ste LL
Duluth, MN 55805-2297
Mailing address
1000 E 1St St Ste LL
Duluth, MN 55805-2297
Phone (218) 249-6230
Other providers in Duluth, MN
- Karin Langford
- Timothy Robert Langguth
- Kayla D Langlee
- Samantha Jo Langlie
- Language of Hair
- Cierra-Ann Laplante
- Natalie Ann Laprairie
- Teri Lee Larson-Johnson
- Amber Dawn Larson
- Amy Larson
All providers in Duluth, MN · Physician Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.