Lisa Kim Deguzman, RD CDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Practice address

38 Madison CT
Wallkill, NY 12589-3006

Phone

(845) 527-5014

NPI assigned

Mar 17, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Lisa Kim Revitz Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Networks

• TX HMO D-SNP
• TX HMO

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/3127/brand/1/csg/21/fhir/r4

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.

• Nourish, Inc.

  • Registered Dietitian
  • Austin, TX
  • NPI 1558097824

  Dietitian, Registered

  NPD (past)

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

{
    "created_epoch": "1679011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679011200000",
    "number": "1013618842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 MADISON CT",
            "city": "WALLKILL",
            "state": "NY",
            "postal_code": "125893006",
            "telephone_number": "845-527-5014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 MADISON CT",
            "city": "WALLKILL",
            "state": "NY",
            "postal_code": "125893006",
            "telephone_number": "845-527-5014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEGUZMAN",
        "first_name": "LISA",
        "middle_name": "KIM",
        "credential": "RD CDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-17",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "REVITZ",
            "middle_name": "KIM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cornerstone Family Healthcare
• Summer Costin, M.S.
• Philip Andrew Crosley, FNP-BC
• Ann Marie Cruver, RN
• Patricia L Decicco, CCC/SLP
• Robert Allen Doyle Jr., DMD
• Sharon Elizabeth Duhon, RN
• Gregory W Duquella, MD
• Lois Olukemi Edwards, FNP-BC
• Samantha Emmert

• Registered Dietitian in Wallkill, NY
• Providers in Wallkill, NY by specialty
• Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.