JACKIE LUTHARDT MD
NPI 1679156202
Obstetrics & Gynecology in Fond Du Lac, WI

Q: What is Jackie Luthardt's NPI number?

The NPI number for Jackie Luthardt is 1679156202. It was assigned to this individual provider in the NPPES registry on May 2, 2021.

Q: What is Jackie Luthardt's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Q: When was this NPI record last updated?

The NPPES record for Jackie Luthardt was last updated on July 31, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months 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 May 02, 2021PECOS EnrolledAccepts Medicare Assignment

420 E DIVISION ST, FOND DU LAC, WI 54935(920) 926-8450 Get Directions Write a Review

NPPES record last updated: July 31, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Jackie Luthardt Md NPPES

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

JACKIE LUTHARDT MD (NPI 1679156202) is an individual obstetrics & gynecology provider in Fond Du Lac, Wisconsin, licensed in Wisconsin (81595-20) and active in the NPI registry since May 2021. She is enrolled in Medicare PECOS, is affiliated with St. Agnes Hospital Hospice, and maintains a secondary practice location in Madison.

NPPES Registry Identity

NPI1679156202

Entity TypeIndividualFemale

Primary Taxonomy207V00000X

Provider Legal NameJACKIE LUTHARDTCredential: MD

Location Address420 E DIVISION STFond Du Lac, WI 54935-4560

Mailing Address749 University Row Ste 200Madison, WI 53705-1465

Phone(920) 926-8450

Sole ProprietorNo

Medical School CMSMichigan State University College Of Human MedicineGraduated 2021

Enumeration DateMay 2, 2021

Last NPPES UpdateJuly 31, 2025

NPPES CertifiedJuly 31, 2025

✔ NPI 1679156202 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians

Taxonomy Code207V00000X

License✔ Licensed in WI · 81595-20

Definition

An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

420 E DIVISION ST, Fond Du Lac, WI 54935

Open in Google Maps ↗

Secondary Practice Location 1

Location 1600 Highland AveMadison, WI 53792-0001 · Phone (608) 263-6400

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Dean Health Plan, Network Health and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jackie Luthardt Md 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 ID4486056801

PECOS Enrollment IDI20251001001633

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.

Medicare Billing Reassignment

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

Agnesian Healthcare Inc

Same address

Family Medicine

420 E DIVISION ST
Fond Du Lac, WI 54935

Reassigned Medicare billing, Wisconsin enrollment
606 clinicians in this Medicare group

NPI 1730162991 (920) 923-7400

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

Hospital Affiliations CMS Care Compare

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

St. Agnes Hospital Hospice

Acute Care Hospitals · Fond Du Lac, WI

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number520088

Location430 E Division StFond Du Lac, WI 54935 · Fond Du Lac County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54935 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

$123.69 typical visit price

range $53.90 – $163.24

Typical copayment $30.92 (range $13.47 – $40.81)

Most-billed visit code 99204

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.

MARY R KELM NP

Nurse Practitioner