NPIMap

Individual provider Active NPI

Lisa Carrie Butler

  • Internal Medicine Physician
  • Pomona, CA
National Provider Identifier
1003885302
Registry record updated Sep 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G77400 Issued in CA
Practice address
790 East Bonita Ave
2ND Floor
Pomona, CA 91767-1906
Phone
(909) 447-8585
Fax
(909) 447-8593
NPI assigned
Mar 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G77400 CA Primary

Addresses

Primary practice location

790 East Bonita Ave
2ND Floor
Pomona, CA 91767-1906

Mailing address

840 Towne Center Dr
Chaparral Medical Group
Pomona, CA 91767-5900
Phone (909) 398-1550

Other identifiers 1

IdentifierTypeStateIssuer
00G774000MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20050412001459 CA Practitioner - Internal Medicine 8426095357 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of California, Geffen School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3260 3Rd Ave
San Diego, CA 92103-5616
Phone (619) 297-3737

Hospital & facility affiliations

  • Mission Home Health of San Diego LLC Home health agency, San Diego, CA, CCN 557711
  • Lorian Health Home health agency, San Diego, CA, CCN 058113
  • Scripps Mercy Hospital Hospital, San Diego, CA, CCN 050077
  • Scripps Memorial Hospital la Jolla Hospital, La Jolla, CA, CCN 050324
  • Sharp Memorial Hospital Hospital, San Diego, CA, CCN 050100
  • Scripps Green Hospital Hospital, La Jolla, CA, CCN 050424
  • Grossmont Hospital Hospital, La Mesa, CA, CCN 050026

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G77400CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chaparral Medical Group, Inc. Current Accepting new patients
Chaparral Medical Group Inc. CurrentSince Feb 28, 2005 Accepting new patients
Chaparral Medical Group Inc Internal Medicine CurrentSince Feb 28, 2005 Accepting new patients
Scripps Health Current Accepting new patients
Internal Medi Cine Associates Medical Group of San Diego, Inc Internal Medicine CurrentSince May 22, 2020 Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients

Locations

1801 W Olympic Blvd
Pasadena, CA 91199

1866 N Orange Grove Ave
Ste 202
Pomona, CA 91767
Phone (909) 623-8796

790 E Bonita Ave
Fl 2
Pomona, CA 91767
Phone (909) 447-8585

840 Towne Center Dr
Pomona, CA 91767

3260 3rd Ave
San Diego, CA 92103
Phone (619) 297-3737

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DBICBA/Endpoint/DBICBA
  • Direct secure messaging: lbutler384835@scrippshlth.medalliesdirect.net

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536710400000",
    "number": "1003885302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 TOWNE CENTER DR",
            "address_2": "CHAPARRAL MEDICAL GROUP",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917675900",
            "telephone_number": "909-398-1550",
            "fax_number": "909-398-1488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 EAST BONITA AVE",
            "address_2": "2ND FLOOR",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671906",
            "telephone_number": "909-447-8585",
            "fax_number": "909-447-8593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "LISA",
        "middle_name": "CARRIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2018-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G77400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G774000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.