NPIMap

Individual provider Active NPI

Lisa G. Distefano, M.D.

  • Internal Medicine Physician
  • Overland Park, KS
National Provider Identifier
1003810789
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0450138 Issued in KS
Practice address
12541 Foster St Ste 300
Overland Park, KS 66213-2304
Phone
(913) 317-3200
Fax
(913) 317-3218
NPI assigned
Jun 9, 2005
Last updated
Nov 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 119536 MO
Internal Medicine Physician 207R00000X 0450138 KS Primary
Pediatrics Physician 208000000X 119536 MO

Addresses

Primary practice location

12541 Foster St Ste 300
Overland Park, KS 66213-2304

Mailing address

12541 Foster St Ste 300
Overland Park, KS 66213-2304
Phone (913) 317-3200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241106001845 KS Practitioner - Internal Medicine 4183768427 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Virginia Commonwealth University, School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saint Lukes Physician Group IncGroup PAC ID 3577476894, 1,233 clinicians

Practice addresses (Care Compare)

12541 Foster St
Suite 300
Overland Park, KS 66213-2304
Phone (913) 317-3200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.56 of 100Reported as group
Quality
76.07
Promoting interoperability
100
Improvement activities
40
Cost
65.79

Merit-based Incentive Payment System (MIPS)

Final score
86.52 of 100Reported as group
Quality
73.6
Promoting interoperability
100
Improvement activities
40
Cost
81.46

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0450138KSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Luke's Physician Group Inc Internal Medicine CurrentSince Oct 28, 2024 Accepting new patients

Locations

711 Marshall St
Leavenworth, KS 66048
Phone (913) 684-1100

12330 Metcalf Ave
Ste 500A
Overland Park, KS 66213
Phone (913) 323-9000

12541 Foster St
Ste 300
Overland Park, KS 66213
Phone (913) 317-3200

901 E 104th St
Ste 400
Kansas City, MO 64131
Phone (816) 502-8752

Networks

  • devoted network organization-2b183dd2-4e80-4977-80a6-4fdf0df4361d
  • devoted network organization-27eb9117-6975-449a-a7ad-909243995ddc
  • devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/chassoc-53c1fd3b
  • Direct secure messaging: ldistefano97133@direct.saint-lukes.org

Organizations & group practices 1

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1003810789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12541 FOSTER ST STE 300",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662132304",
            "telephone_number": "913-317-3200",
            "fax_number": "913-317-3218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12541 FOSTER ST STE 300",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662132304",
            "telephone_number": "913-317-3200",
            "fax_number": "913-317-3218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTEFANO",
        "first_name": "LISA",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-09",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "119536",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "0450138",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "119536",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

Verify at the official NPI Registry.