NPIMap

Individual provider Active NPI

Laura Alice Peterson, MD

  • Vascular Surgery Physician
  • La Crosse, WI
National Provider Identifier
1881853307
Registry record updated Sep 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
73795 Issued in WI
Practice address
1836 South Ave
La Crosse, WI 54601-5429
Phone
(608) 782-7300
NPI assigned
Jun 9, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 35.096139 OH
Vascular Surgery Physician 2086S0129X 35-096139 OH
Vascular Surgery Physician 2086S0129X 73795 WI Primary

Addresses

Primary practice location

1836 South Ave
La Crosse, WI 54601-5429

Mailing address

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

Other practice location 1

2300 Miami Valley Dr Ste 350
Centerville, OH 45459
Phone (937) 438-8640

Other practice location 2

30 E Apple St
Ste 5253
Dayton, OH 45409-2939
Phone (937) 208-2552

Other practice location 3

3130 N County Road 25A Ste 214
Troy, OH 45373-1337
Phone (937) 438-8640

Other identifiers 1

IdentifierTypeStateIssuer
0159725MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210928000939 WI Practitioner - Vascular SurgeryPractitioner - General Surgery 6204077837 Reassigns benefits to 1 organization
I20211108000573 IA Practitioner - Vascular Surgery 6204077837 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gundersen Regional Clinics, LLCGroup PAC ID 8820450919, 51 clinicians
Gundersen Lutheran Medical Center IncGroup PAC ID 2163331414, 888 clinicians

Practice addresses (Care Compare)

1830 State Hwy 9
Suite 100
Decorah, IA 52101-7301
Phone (563) 382-3140

1836 S Ave
La Crosse, WI 54601-5429
Phone (608) 783-7300

Hospital & facility affiliations

  • Gundersen Lutheran Medical Center Hospital, La Crosse, WI, CCN 520087
  • Gundersen Palmer Lutheran Hospital and Clinics Hospital, West Union, IA, CCN 161316
  • Winnmed Hospital, Decorah, IA, CCN 161371
  • Vernon Memorial Hospital Hospital, Viroqua, WI, CCN 521348
  • Mayo Clinic Health System-Franciscan Medical Center Inc Hospital, La Crosse, WI, CCN 520004

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10
Leg revascularization (restoring blood flow)1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35-096139OHMDVascular Surgery Physician
73795WIMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gundersen Regional Clinics, LLC CurrentSince Oct 1, 2023 Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Sep 20, 2021 Accepting new patients
Gundersen Regional Clinics LLC CurrentSince Oct 1, 2023 Accepting new patients
Gundersen Lutheran Express Care, Inc CurrentSince Dec 3, 2021 Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Sep 20, 2021 Accepting new patients
Palmer Lutheran Health Center, Inc. CurrentSince Jan 1, 2026 Accepting new patients
Gundersen Lutheran Medical Center Inc Current Accepting new patients
Palmer Lutheran Health Center, Inc. CurrentSince Feb 21, 2022 Accepting new patients
Gundersen Clinic LTD CurrentSince Dec 3, 2021 Accepting new patients
Gundersen Lutheran Medical Center Inc Past Accepting new patients

Locations

1830 State Highway 9
Ste 100
Decorah, IA 52101
Phone (563) 382-3140

1830 State Highway 9
Decorah, IA 52101
Phone (563) 382-2639

110 Jefferson St
West Union, IA 52175
Phone (319) 422-3817

112 Jefferson St
West Union, IA 52175
Phone (563) 422-3811

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

Interoperability endpoints

  • Direct secure messaging: lpeterson553644@direct.emplifyhealth.org

Organizations & group practices 10

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 11

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": "1212969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1881853307",
    "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": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2300 Miami Valley Dr Ste 350",
            "address_purpose": "LOCATION",
            "city": "Centerville",
            "state": "OH",
            "postal_code": "45459",
            "country_code": "US",
            "telephone_number": "937-438-8640",
            "fax_number": "937-438-8615",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "30 E Apple St",
            "address_2": "Ste 5253",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454092939",
            "country_code": "US",
            "telephone_number": "937-208-2552",
            "fax_number": "937-208-6154",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3130 N County Road 25A Ste 214",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "OH",
            "postal_code": "453731337",
            "country_code": "US",
            "telephone_number": "937-438-8640",
            "fax_number": "937-438-8615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "LAURA",
        "middle_name": "ALICE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-09",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35.096139",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "OH",
            "license": "35-096139",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "WI",
            "license": "73795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0159725",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Crosse, WI

Sources for this page

Verify at the official NPI Registry.