Jeremy R. Luedtke, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

01079264A Issued in IN

Practice address

400 Legacy PLZ W
La Porte, IN 46350-5296

Phone

(219) 379-3166

Fax

(219) 324-9730

NPI assigned

May 14, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WI, IN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

General Surgery

Education

Medical College of Wisconsin, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Porter Physician Services LLCGroup PAC ID 1850482407, 96 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwest Health - Porter Hospital, Valparaiso, IN, CCN 150035

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jeremy.luedtke.1@2340.direct.athenahealth.com

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.

• Porter Physician Services LLC

  • Family Medicine Physician
  • Valparaiso, IN
  • NPI 1508075680
  Medicare reassignment Care Compare group NPD
• Surgical Associates of Neenah, S.C.

  • Surgery Physician
  • Neenah, WI
  • NPI 1285792341
  Medicare reassignment NPD
• Thedacare, Incorporated

  • Family Medicine Physician
  • New London, WI
  • NPI 1376656959
  Medicare reassignment NPD
• Porter Physician Services LLC

  • Internal Medicine Physician
  • Portage, IN
  • NPI 1457566309
  NPD (past)

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

• Porter Hospital LLC

  • General Acute Care Hospital
  • Valparaiso, IN
  • NPI 1215151154
  Care Compare affiliation

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1891900783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 LEGACY PLZ W",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463505296",
            "telephone_number": "219-379-3166",
            "fax_number": "219-324-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 LEGACY PLZ W",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463505296",
            "telephone_number": "219-379-3166",
            "fax_number": "219-324-9730"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1715 Dousman St",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543033211",
            "country_code": "US",
            "telephone_number": "920-496-4700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1715 Dousman St",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543033211",
            "country_code": "US",
            "telephone_number": "920-496-4700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUEDTKE",
        "first_name": "JEREMY",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-14",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301087609",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "57033-20",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01079264A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE #",
            "identifier": "07028",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300008363",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "IN2920085",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in La Porte, IN
• Providers in La Porte, IN by specialty
• Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.