Kali Luecke, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PAC0748 Issued in ND

Practice address

301 NP Ave N
Fargo, ND 58102-4835

Phone

(701) 271-3344

Fax

(701) 271-1480

NPI assigned

Aug 4, 2016

Last updated

Jan 21, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kali Shephard Former name

Medicare fee-for-service enrollment

Enrolled in ND

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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Presentation Medical CenterGroup PAC ID 5991764045, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Presentation Medical Center Hospital, Rolla, ND, CCN 351316

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Presentation Medical Center

  • Critical Access Hospital
  • Rolla, ND
  • NPI 1265404958
  Medicare reassignment Care Compare group
• Presentation Medical Center

  • Clinic/Center
  • Rolla, ND
  • NPI 1992014518
  NPD
• Presentation Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Rolla, ND
  • NPI 1619033917
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Presentation Medical Center

  • Critical Access Hospital
  • Rolla, ND
  • NPI 1265404958
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548028800000",
    "number": "1881148005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 NP AVE N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581024835",
            "telephone_number": "701-271-3344",
            "fax_number": "701-271-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 NP AVE N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581024835",
            "telephone_number": "701-271-3344",
            "fax_number": "701-271-1480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUECKE",
        "first_name": "KALI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-04",
        "last_updated": "2019-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085.005909",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ND",
            "license": "PAC0748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KALI",
            "last_name": "SHEPHARD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michael Samuel Lucin, M.D.
• Maria Lucio
• Megen Lucy
• Rachel Lucy
• Rodney A Ludwig, M.D.
• Elizabeth A Luft, LMFT
• Brynn A Luger, MA., LPCC, NCC
• Patrick A Luger, MD
• Kimberly A Luithle, CRNA
• Lumen Vision PC

• Medical Physician Assistant in Fargo, ND
• Providers in Fargo, ND by specialty
• Medical Physician Assistant in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.