NPIMap

Organization Active NPI

Gundersen Clinic, LTD.

  • Clinic/Center
  • Waukon, IA
National Provider Identifier
1831144302
Registry record updated Aug 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
GUNDERSEN CLINIC, LTD.
Practice address
120 2ND Avenue SE
Waukon, IA 52172
Phone
(608) 782-7300
NPI assigned
May 23, 2006
Organization subpart
Yes
Parent organization
GUNDERSEN CLINIC, LTD.As reported in NPPES

Authorized official

NPPES NPI Registry
Name
Kari B Adank
Title
Cco
Phone
(608) 775-8025

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20040130000561 IA Part B Supplier - Clinic/Group Practice 9638082779 Receives reassigned benefits from 191 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lansing, IA; McGregor, IA; Monona, IA; Oelwein, IA; Ossian, IA; Postville, IA; Waukon, IA; Decorah, IA…
O20100930000611 IA DME Supplier - Multi-Specialty - PhysicianDME Supplier - Physician - OptometristDME Supplier - Optician 9638082779 Practice locations: Waukon, IA

National Provider Directory

National Provider Directory
Tax ID family
La Liberte-Gundersen VI (52 organizations share this tax ID)
Part of
La Liberte-Gundersen VI

Locations

1900 South Ave
Ofc
La Crosse, WI 54601

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

NPPES NPI Registry

Primary practice location

120 2ND Avenue SE
Waukon, IA 52172

Mailing address

1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300

Other names 1

NPPES NPI Registry
  • GL Waukon Clinic Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 6, 2021.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1831144302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 2ND AVENUE SE",
            "city": "WAUKON",
            "state": "IA",
            "postal_code": "52172",
            "telephone_number": "608-782-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUNDERSEN CLINIC, LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GUNDERSEN CLINIC, LTD.",
        "enumeration_date": "2006-05-23",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A",
        "authorized_official_last_name": "ADANK",
        "authorized_official_first_name": "KARI",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "608-775-8025"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GL Waukon Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Waukon, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.