NPIMap

Organization Active NPI

Drlullaby LLC

  • Clinic/Center
  • Union Grove, WI
National Provider Identifier
1003520149
Registry record updated Mar 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
DRLULLABY LLC
Practice address
4380 67TH Dr # 1033
Union Grove, WI 53182-9338
Phone
(844) 475-3379
Fax
(855) 644-2985
NPI assigned
Jan 12, 2023
Last updated
Mar 14, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
DRLULLABY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 14, 2023

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

Authorized official

Name
Lisa Ann MedalieNPI 1609175744
Title
Ceo
Phone
(619) 997-5759

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TB0200X
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

4380 67TH Dr # 1033
Union Grove, WI 53182-9338

Mailing address

1440 W Taylor St # 556
Chicago, IL 60607-4623
Phone (844) 475-3379

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230427002977 WI Part B Supplier - Clinic/Group Practice 9931507290 Receives reassigned benefits from 1 practitioner
Practice locations: Union Grove, WI

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Drlullaby LLC9 organizations share this tax ID, including this one
Part of
Drlullaby LLC

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1673481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678752000000",
    "number": "1003520149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 W TAYLOR ST # 556",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606074623",
            "telephone_number": "844-475-3379",
            "fax_number": "855-644-2985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4380 67TH DR # 1033",
            "city": "UNION GROVE",
            "state": "WI",
            "postal_code": "531829338",
            "telephone_number": "844-475-3379",
            "fax_number": "855-644-2985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRLULLABY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DRLULLABY LLC",
        "enumeration_date": "2023-01-12",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A",
        "authorized_official_last_name": "MEDALIE",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "619-997-5759"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Union Grove, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.