Individual provider Active NPI

Laura Lee Stang, PA-C

  • Physician Assistant
  • Sartell, MN
National Provider Identifier
1790311934
Registry record updated Mar 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1171286 Issued in MN
Practice address
2351 Connecticut Ave S Ste 200
Sartell, MN 56377-2477
Phone
(320) 259-1411
NPI assigned
Mar 19, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 1171286 MN
Physician Assistant 363A00000X 1171286 MN Primary

Addresses

Primary practice location

2351 Connecticut Ave S Ste 200
Sartell, MN 56377-2477

Mailing address

2351 Connecticut Ave S Ste 200
Sartell, MN 56377-2477

Other names 1

  • Laura Lee Traut Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL EPIC Health Information Exchange (HIE)

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: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200508001465 MN Practitioner - Physician Assistant 9739510629 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

1406 6TH Ave N
St Cloud, MN 56303-1901

1406 6TH Ave No
St Cloud, MN 56303-1901

1900 Centracare Cir
Saint Cloud, MN 56303-5000

2351 Connecticut Ave S
Suite 200
Sartell, MN 56377-2477
Phone (320) 259-1411

PO Box
Chicago, IL 60673

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1171286MNMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Southwest LLC CurrentSince Apr 6, 2022 Accepting new patients
Centracare Clinic CurrentSince May 1, 2020 Accepting new patients
Centracare Clinic CurrentSince May 1, 2020 Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

600 Peterson Pkwy
New London, MN 56273
Phone (320) 354-2222

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

2351 Connecticut Ave S
Ste 200
Sartell, MN 56377
Phone (320) 203-6906

Interoperability endpoints

  • Direct secure messaging: lstang518389@direct.centracare.com

Organizations & group practices 6

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 6

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": "1584576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584576000000",
    "number": "1790311934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2351 CONNECTICUT AVE S STE 200",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2351 CONNECTICUT AVE S STE 200",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772477",
            "telephone_number": "320-259-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANG",
        "first_name": "LAURA",
        "middle_name": "LEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-19",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "1171286",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "1171286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "EPIC",
            "affiliation": "N",
            "endpointDescription": "Electronic medical record",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EMR",
            "address_1": "2351 Connecticut Ave S Ste 200",
            "city": "Sartell",
            "state": "MN",
            "country_code": "US",
            "postal_code": "563772477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "TRAUT",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sartell, MN

Sources for this page

Verify at the official NPI Registry.