Individual provider Active NPI

Lisa Santos Spector, MD

  • Developmental - Behavioral Pediatrics Physician
  • Orlando, FL
National Provider Identifier
1003927112
Registry record updated Apr 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
License
ME133729 Issued in FL
Practice address
13535 Nemours Pkwy
Orlando, FL 32827-7402
Phone
(407) 567-4000
Fax
(407) 567-5924
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2019

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME96905 FL
Pediatrics Physician 208000000X 04-33344 KS
Pediatrics Physician 208000000X 2008021141 MO
Pediatric Neurodevelopmental Disabilities Physician 2080P0008X ME133729 FL
Developmental - Behavioral Pediatrics Physician 2080P0006X ME133729 FL Primary

Addresses

Primary practice location

13535 Nemours Pkwy
Orlando, FL 32827-7402

Mailing address

10140 Centurion Pkwy N
Jacksonville, FL 32256-0532
Phone (904) 697-4100

Other identifiers 2

IdentifierTypeStateIssuer
022874200MedicaidFL
2763362-00MedicaidFL

Other names 1

  • Lisa Santos Kresnicka Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070404000199 FL Practitioner - Pediatric Medicine 4587620562 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
04-33344KSMDPediatrics Physician
2008021141MOMDPediatrics Physician
ME133729FLMDDevelopmental - Behavioral Pediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Nemours Foundation CurrentSince Oct 30, 2017 Accepting new patients
The Nemours Foundation Current Accepting new patients
The Nemours Foundation CurrentSince Oct 30, 2017 Accepting new patients

Locations

807 Childrens Way
Jacksonville, FL 32207
Phone (904) 390-3600

10140 Centurion Pkwy N
Jacksonville, FL 32256
Phone (904) 697-4100

6535 Nemours Pkwy
Orlando, FL 32827
Phone (407) 567-4000

Interoperability endpoints

  • Direct secure messaging: lspector69841@direct.nemours.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556236800000",
    "number": "1003927112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10140 CENTURION PKWY N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560532",
            "telephone_number": "904-697-4100",
            "fax_number": "904-697-5102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13535 NEMOURS PKWY",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328277402",
            "telephone_number": "407-567-4000",
            "fax_number": "407-567-5924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPECTOR",
        "first_name": "LISA",
        "middle_name": "SANTOS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2019-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME96905",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KS",
            "license": "04-33344",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2008021141",
            "primary": false
        },
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "FL",
            "license": "ME133729",
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "FL",
            "license": "ME133729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022874200",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2763362-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "KRESNICKA",
            "middle_name": "SANTOS",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.