Individual provider Active NPI

Landon Lauber

  • Certified Registered Nurse Anesthetist
  • Plymouth, IN
National Provider Identifier
1902679160
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
149768 Issued in IN
Practice address
1915 Lake Ave
Plymouth, IN 46563-9366
Phone
(574) 948-4911
NPI assigned
Oct 31, 2023
Last updated
Sep 27, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 149768 IN Primary
School Registered Nurse 163WS0200X 28243465A IN

Addresses

Primary practice location

1915 Lake Ave
Plymouth, IN 46563-9366

Mailing address

1700 Hope Blvd
Plymouth, IN 46563-1253
Phone (574) 555-5555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240622000512 IN Practitioner - Certified Registered Nurse Anesthetist (Crna) 9436692126 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Marian University College of Osteopathic Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Great Lakes Anesthesia PCGroup PAC ID 0648183442, 4 clinicians
Cep America - Anesthesia PCGroup PAC ID 3678897915, 849 clinicians

Practice addresses (Care Compare)

1915 Lake Ave
Plymouth, IN 46563-9366
Phone (574) 948-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
28243465AINMDSchool Registered Nurse
149768INMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - Anesthesia PC CurrentSince Oct 31, 2025 Accepting new patients
Cep America - Anesthesia PC Current Accepting new patients
Ams Northern Indiana LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2024 Accepting new patients
Great Lakes Anesthesia, P.C. Nurse Anesthetist, Certified Registered CurrentSince May 15, 2024 Accepting new patients
Cep America - Anesthesia PC CurrentSince Oct 31, 2025 Accepting new patients
Saint Joseph Regional Medical Center- Plymouth Campus Inc Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

1004 Parkway Ave
Ste A
Elkhart, IN 46516
Phone (800) 966-7841

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

1915 Lake Ave
Plymouth, IN 46563
Phone (219) 936-3181

1400 E 9th St
Rochester, IN 46975
Phone (574) 223-2020

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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": "1698710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1902679160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 HOPE BLVD",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465631253",
            "telephone_number": "574-555-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 LAKE AVE",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465639366",
            "telephone_number": "574-948-4911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAUBER",
        "first_name": "LANDON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-31",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "149768",
            "primary": true
        },
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "IN",
            "license": "28243465A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.