LABUTALE WALAWWE RAJAGURU PA-C
NPI 1346006772
Physician Assistant in Superior, WI

Active since February 23, 2024PECOS EnrolledAccepts Medicare Assignment
3500 TOWER AVE, SUPERIOR, WI 54880(715) 817-7100 Get Directions Write a Review

NPPES record last updated: February 23, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Labutale Walawwe Rajaguru Pa-c NPPES

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

LABUTALE WALAWWE RAJAGURU PA-C (NPI 1346006772) is an individual physician assistant in Superior, Wisconsin, licensed in Wisconsin (7735) and active in the NPI registry since February 2024. He is enrolled in Medicare PECOS, is affiliated with St Marys Hospital Superior, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1346006772
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameLABUTALE WALAWWE RAJAGURUCredential: PA-C
Location Address3500 TOWER AVESuperior, WI 54880-4491
Mailing Address400 E 3rd StDuluth, MN 55805-1951 · (218) 786-8364
Sole ProprietorNo
Medical School CMSOtherGraduated 2023
Enumeration DateFebruary 23, 2024
NPPES CertifiedFebruary 23, 2024
NPI 1346006772 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Licenses Licensed in WI · 7735 Licensed in MN · 14754
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
3500 TOWER AVE, Superior, WI 54880

Other Names 1

Other Name (5)Udara Rajaguru Pa-c

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Labutale Walawwe Rajaguru Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8325488364
PECOS Enrollment IDI20240424003352
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Marys Hospital Superior

Critical Access Hospitals · Superior, WI
OwnershipVoluntary non-profit - Private
CMS Certification Number521329
Location3500 Tower AveSuperior, WI 54880 · Douglas County
Emergency services

Spooner Health System

Critical Access Hospitals · Spooner, WI
OwnershipVoluntary non-profit - Private
CMS Certification Number521332
Location1280 Chandler DrSpooner, WI 54801 · Washburn County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54880 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.92 typical visit price
range $53.90 – $163.24
Typical copayment $20.73 (range $13.47 – $40.81)
Most-billed visit code 99203
Established Patient
$67.37 typical visit price
range $17.40 – $133.76
Typical copayment $16.84 (range $4.35 – $33.44)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

Physician Assistant
3500 TOWER AVE
SUPERIOR, WI 54880
Internal Medicine
3500 TOWER AVE
SUPERIOR, WI 54880
Physical Therapist (Sports)
3500 TOWER AVE
SUPERIOR, WI 54880
Hospitalist
3500 TOWER AVE
SUPERIOR, WI 54880
Pharmacist
3500 TOWER AVE
SUPERIOR, WI 54880
Physical Therapist
3500 TOWER AVE
SUPERIOR, WI 54880
Physician Assistant
3500 TOWER AVE
SUPERIOR, WI 54880
General Acute Care Hospital (Critical Access)
3500 TOWER AVE
SUPERIOR, WI 54880

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 Labutale Walawwe Rajaguru's NPI number?

The NPI number for Labutale Walawwe Rajaguru is 1346006772. It was assigned to this individual provider in the NPPES registry on February 23, 2024. The provider is also known as Udara Rajaguru Pa-C.

Where is Labutale Walawwe Rajaguru located?

Labutale Walawwe Rajaguru practices at 3500 Tower Ave, Superior, WI 54880. The listed phone number is (715) 817-7100.

What is Labutale Walawwe Rajaguru's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Labutale Walawwe Rajaguru enrolled in Medicare?

Yes. Labutale Walawwe Rajaguru is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Labutale Walawwe Rajaguru accept?

Health plans from Anthem Blue Cross and Blue Shield and Medica list Labutale Walawwe Rajaguru as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Labutale Walawwe Rajaguru affiliated with any hospitals?

According to CMS data, Labutale Walawwe Rajaguru is affiliated with St Marys Hospital Superior and Spooner Health System.

When was this NPI record last updated?

The NPPES record for Labutale Walawwe Rajaguru was last updated on February 23, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.