KONNIE SUE LUCZAK RD, LD
NPI 1114359205
Dietitian, Registered in Woodbury, MN

Q: What is Konnie Luczak's NPI number?

The NPI number for Konnie Luczak is 1114359205. It was assigned to this individual provider in the NPPES registry on July 31, 2013.

Q: What is Konnie Luczak's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Q: When was this NPI record last updated?

The NPPES record for Konnie Luczak was last updated on April 5, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 31, 2013

237 RADIO DR STE 210, WOODBURY, MN 55125(612) 871-1145(612) 870-5491 Get Directions Write a Review

NPPES record last updated: April 5, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

On this page

About Konnie Sue Luczak Rd, Ld NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KONNIE SUE LUCZAK RD, LD (NPI 1114359205) is an individual dietitian, registered in Woodbury, Minnesota, licensed in Minnesota (3245) and active in the NPI registry since July 2013.

NPPES Registry Identity

NPI1114359205

Entity TypeIndividualFemale

Primary Taxonomy133V00000X

Provider Legal NameKONNIE SUE LUCZAKCredential: RD, LD

Location Address237 RADIO DR STE 210Woodbury, MN 55125-4478

Mailing Address1900 Centracare Cir, Centracare Clinic Health PlazaSaint Cloud, MN 56303-5000 · (320) 229-4916 · Fax (320) 229-5174

Phone(612) 871-1145

Fax(612) 870-5491

Sole ProprietorNo

Enumeration DateJuly 31, 2013

Last NPPES UpdateApril 5, 2022

NPPES CertifiedApril 5, 2022

✔ NPI 1114359205 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers

Taxonomy Code133V00000X

License✔ Licensed in MN · 3245

Definition

A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.

237 RADIO DR STE 210, Woodbury, MN 55125

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Konnie Sue Luczak Rd, Ld is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

Medicare enrollment records show Konnie Luczak reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Mngi Digestive Health, P.A.

15 mi

Gastroenterology

3001 BROADWAY ST NE STE 500
Minneapolis, MN 55413

Reassigned Medicare billing, Minnesota enrollment
Medicare enrollment name: Mngi Digestive Health PA
322 clinicians in this Medicare group

NPI 1609804541 (612) 871-1145

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARISA ANN SPENCER MD

Internal Medicine (Gastroenterology)

237 RADIO DR STE 210
WOODBURY, MN 55125

Washington County (612) 871-1145

DR. KEVIN RANK M.D

Internal Medicine (Gastroenterology)

237 RADIO DR STE 210
SAINT PAUL, MN 55125

Washington County (612) 874-1114

SEAN M TEAGARDEN D.O.

Internal Medicine (Gastroenterology)

237 RADIO DR STE 210
WOODBURY, MN 55125

Washington County (612) 871-1145

VALERIE LAUERMANN RN

Registered Nurse (Gastroenterology)

237 RADIO DR STE 210
WOODBURY, MN 55125

Washington County (612) 871-1145

NADEEM AHMAD CHAUDHARY MD

Internal Medicine (Gastroenterology)

237 RADIO DR STE 210
WOODBURY, MN 55125

Washington County (612) 871-1145

DR. MARK EDWARD SMITH D.O.

Internal Medicine (Gastroenterology)

237 RADIO DR STE 210
WOODBURY, MN 55125

Washington County (612) 871-1145

MRS. JENNA M CARBONE APRN, FNP-C

Registered Nurse

237 RADIO DR STE 210
WOODBURY, MN 55125

Washington County (612) 871-1145

AWAH L DITAH NP

Nurse Practitioner (Family)

237 RADIO DR STE 210
WOODBURY, MN 55125

Washington County (612) 871-1145

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Konnie Luczak's NPI number?

The NPI number for Konnie Luczak is 1114359205. It was assigned to this individual provider in the NPPES registry on July 31, 2013.

Where is Konnie Luczak located?

Konnie Luczak practices at 237 Radio Dr Ste 210, Woodbury, MN 55125. The listed phone number is (612) 871-1145.

What is Konnie Luczak's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Is Konnie Luczak enrolled in Medicare?

Yes. Konnie Luczak is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Konnie Luczak's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Konnie Luczak reassigns Medicare benefits to Mngi Digestive Health, P.A. (Minneapolis, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Konnie Luczak's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Konnie Luczak was last updated on April 5, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.