Individual provider Active NPI

Lisa Anne Werner, PA

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1013340629
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085005553 Issued in IL
Practice address
3860 W Ogden Ave
Chicago, IL 60623-2460
Phone
(872) 588-3000
Fax
(872) 588-3021
NPI assigned
Aug 19, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2378 TN
Physician Assistant 363A00000X 085-005553 IL
Physician Assistant 363A00000X 085005553 IL Primary

Addresses

Primary practice location

3860 W Ogden Ave
Chicago, IL 60623-2460

Mailing address

3860 W Ogden Ave
Chicago, IL 60623-2460
Phone (872) 588-3000

Other identifiers 3

IdentifierTypeStateIssuer
385004177OtherILCS LICENSE
085005553OtherILSTATE LICENSE
1111165OtherILSPECIALTY BOARDS

Other names 1

  • Lisa Ann Cole Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151111000469 IL Practitioner - Physician Assistant 9739313990 Reassigns benefits to 2 organizations

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085-005553ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Anthony Health Affiliates CurrentSince Aug 21, 2020 Accepting new patients
Lawndale Christian Health Center CurrentSince Oct 10, 2015 Accepting new patients
Lawndale Christian Health Center CurrentSince Oct 10, 2015 Accepting new patients
Saint Anthony Health Affiliates Physician Assistant CurrentSince Aug 21, 2020 Accepting new patients
Lawndale Christian Health Center Current Accepting new patients
Lawndale Christian Health Center Current Accepting new patients

Locations

3860 W Ogden Ave
Chicago, IL 60623
Phone (872) 588-3000

4696 Paysphere Cir
Chicago, IL 60674

4177 S Archer Ave
Chicago, IL 60632
Phone (773) 254-2222

Interoperability endpoints

  • Direct secure messaging: lwerner691142@direct.ochin.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1376870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1013340629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 W OGDEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606232460",
            "telephone_number": "872-588-3000",
            "fax_number": "872-588-3001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3860 W OGDEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606232460",
            "telephone_number": "872-588-3000",
            "fax_number": "872-588-3021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WERNER",
        "first_name": "LISA",
        "middle_name": "ANNE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-19",
        "last_updated": "2023-03-07",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "2378",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-005553",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085005553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CS LICENSE",
            "identifier": "385004177",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "085005553",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECIALTY BOARDS",
            "identifier": "1111165",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "COLE",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.