Lai Thao, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1923-23 Issued in WI

Practice address

11051 N Sherman Rd
Edgerton, WI 53534-9002

Phone

(608) 884-3354

Fax

(608) 884-5024

NPI assigned

May 12, 2006

Last updated

Jun 28, 2021By 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 identifiers 1

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in WI, MN2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Monroe Clinic, Inc.Group PAC ID 3072425495, 199 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lthao320595@excellian.direct.allina.com

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.

• The Monroe Clinic, Inc.

  dba SSM Health Monroe Clinic Medical Group

  • Specialist
  • Monroe, WI
  • NPI 1386720548
  Medicare reassignment Care Compare group NPD
• Dean Health Systems, Inc

  dba SSM Health Dean Medical Group

  • Allergy & Immunology Physician
  • Madison, WI
  • NPI 1053358846
  Medicare reassignment NPD
• Group Health, Inc.

  dba HealthPartners Medical Group

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1710924683
  Medicare reassignment NPD
• St. Francis Regional Medical Center

  dba St. Francis Urgent Care - Southbridge

  • Urgent Care Clinic/Center
  • Shakopee, MN
  • NPI 1447605514
  Medicare reassignment NPD
• Group Health Cooperative of South Central Wisconsin

  • Health Maintenance Organization
  • Madison, WI
  • NPI 1245260165
  Medicare reassignment
• Allina Health System

  dba Allina Health Buffalo Specialty Clinic

  • Obstetrics & Gynecology Physician
  • Buffalo, MN
  • NPI 1295272342
  Medicare reassignment
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  WI

  Medicare reassignment
• Dean Health Systems, Inc.

  dba SSM Health Davis Duehr Dean Eye Care - Portage

  • Durable Medical Equipment & Medical Supplies
  • Portage, WI
  • NPI 1427085679
  NPD
• The Monroe Clinic, Inc.

  dba SSM Health Monroe Hospital

  • General Acute Care Hospital
  • Monroe, WI
  • NPI 1740291491
  NPD
• Allina Health System

  dba Allina Health Surgical Specialists

  • Surgery Physician
  • Minneapolis, MN
  • NPI 1841737996
  NPD
• Allina Health System

  dba Allina Health TeleRheumatology

  • Rheumatology Physician
  • Coon Rapids, MN
  • NPI 1952146516
  NPD
• Group Health, Inc.

  dba HealthPartners Midway Residency Dental

  • General Practice Dentistry
  • Saint Paul, MN
  • NPI 1952042053
  NPD

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1922059120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11051 N SHERMAN RD",
            "city": "EDGERTON",
            "state": "WI",
            "postal_code": "535349002",
            "telephone_number": "608-884-3354",
            "fax_number": "608-884-5024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11051 N SHERMAN RD",
            "city": "EDGERTON",
            "state": "WI",
            "postal_code": "535349002",
            "telephone_number": "608-884-3354",
            "fax_number": "608-884-5024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAO",
        "first_name": "LAI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11615",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1923-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922059120",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lthao320595@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "9409 Zane Ave N",
            "city": "Brooklyn Park",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554431814",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "11051 N Sherman Rd",
            "city": "Edgerton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535349002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lthao396916@direct-ehr-ssmmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "lthao396916@direct-ehr-ssmmhc.com",
            "address_1": "11051 N Sherman Rd",
            "city": "Edgerton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535349002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sport & Spine Clinic of Fort Atkinson Limited Partnership (Sport & Spine Clinic of Edgerton)
• Lydia Stevenson, RDN
• Charlene Fay Stipes, PTA
• Susan C. Stockel, OTR
• Joni E Sund, PA C
• Thomas H Reitz DDS SC
• Kevin C Trampe, PHARMD
• True Health and Performance LLC
• Tonya Jo Vike, RN
• Daphne Wang, SPEECH PATHOLOGIST

• Physician Assistant in Edgerton, WI
• Providers in Edgerton, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; 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.