Lisa Jeanne Maddox

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

MH22914 Issued in FL

Practice address

4243 Sunbeam Rd Ste 1
Jacksonville, FL 32257-8975

Phone

(855) 284-7483

Fax

(617) 807-0958

NPI assigned

Oct 11, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Thriveworks Clinical - Florida IncGroup PAC ID 5496173577, 85 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• FL PPO
• FL HMO C-SNP
• FL HMO

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.

• Thriveworks Clinical - Florida Inc

  • Mental Health Counselor
  • Fort Lauderdale, FL
  • NPI 1396360996
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1665446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1013632116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 748465",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303748465",
            "telephone_number": "855-284-7483",
            "fax_number": "617-807-0958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4243 SUNBEAM RD STE 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322578975",
            "telephone_number": "855-284-7483",
            "fax_number": "617-807-0958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADDOX",
        "first_name": "LISA",
        "middle_name": "JEANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-11",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH22914",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "FL",
            "license": "MH22914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kate McDowell Madden, NP
• Bruce Robert Maddern, MD
• Charles B Maddix, APRN, MSN, PMHNP-BC
• Jennifer J Maddox, CRNA
• Karen B Maddox, MA
• Supradeep Shree Venkata Madduri
• Colin Mader, DPT
• Jenna Mader
• Courtney L Madera, PT DPT
• Morgan Taylor Madetzke

• Professional Counselor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Professional Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.