Kali Luecke, PA-C
Individual provider Active NPI Medical Physician Assistant · Fargo, ND
NPI 1881148005 · NPPES record last updated Jan 21, 2019
Key facts
- NPI
- 1881148005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PAC0748 (ND)
- Practice address
- 301 NP Ave N
Fargo, ND 58102-4835 - Phone
- (701) 271-3344
- Fax
- (701) 271-1480
- NPI assigned
- Aug 4, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Presentation Medical Center
Practice addresses (Care Compare)
213 2ND Ave NE
Rolla, ND 58367-7153
Phone (701) 477-3161
Hospital & facility affiliations
- Presentation Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- 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 |
|---|---|---|---|---|
| I20190409003282 | ND | Practitioner - Physician Assistant | 5294022109 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085.005909 | IL | MD | Medical Physician Assistant |
| PAC0748 | ND | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Presentation Medical Center | Current |
Accepting new patients | |
| Presentation Medical Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 085.005909 | IL | |
| Medical Physician Assistant | 363AM0700X | PAC0748 | ND | Yes |
Addresses
Primary practice location
301 NP Ave N
Fargo, ND 58102-4835
Mailing address
301 NP Ave N
Fargo, ND 58102-4835
Phone (701) 271-3344
Other names
- Kali Shephard
Other providers in Fargo, ND
- Michael Samuel Lucin
- Maria Lucio
- Megen Lucy
- Rachel Lucy
- Rodney A Ludwig
- Elizabeth A Luft
- Brynn A Luger
- Patrick A Luger
- Kimberly A Luithle
- Lumen Vision PC
All providers in Fargo, ND · Medical Physician Assistant in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2019. 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.