NPIMap

Individual provider Active NPI

Lisa M Ivy, ANP

  • Acute Care Nurse Practitioner
  • Little Rock, AR
National Provider Identifier
1033103296
Registry record updated Feb 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
A01826 Issued in AR
Practice address
7 Shackleford West Blvd
Little Rock, AR 72211-3714
Phone
(501) 664-5860
Fax
(501) 664-0889
NPI assigned
Sep 2, 2005
Last updated
Feb 16, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X A01826 AR Primary

Addresses

Primary practice location

7 Shackleford West Blvd
Little Rock, AR 72211-3714

Mailing address

7 Shackleford West Blvd
Little Rock, AR 72211-3714
Phone (501) 664-5860

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20050318000893 AR Practitioner - Nurse Practitioner 4880645878 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Vanderbilt University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arkansas Heart Hospital Rural Health Services, LLCGroup PAC ID 6204004815, 52 clinicians
Arkansas Heart Hospital LLCGroup PAC ID 6002838653, 85 clinicians

Practice addresses (Care Compare)

209 S Portland Ave
Unit 2
Russellville, AR 72801-2339
Phone (501) 664-5860

7 Shackleford W Blvd
Little Rock, AR 72211-3886
Phone (501) 664-5860

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A01826ARMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Arkansas Heart Hospital Rural Health Services, LLC CurrentSince Aug 1, 2011 Accepting new patients
Arkansas Heart Hospital, LLC CurrentSince Aug 1, 2011 Accepting new patients
Arkansas Heart Hospital, LLC CurrentSince Aug 1, 2011 Accepting new patients

Locations

7 Shackleford West Blvd
Little Rock, AR 72211
Phone (501) 614-3671

209 S Portland Ave
Russellville, AR 72801
Phone (479) 317-7010

209 S Portland Ave
Unit 2
Russellville, AR 72801
Phone (479) 967-0690

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266278400000",
    "number": "1033103296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 SHACKLEFORD WEST BLVD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113714",
            "telephone_number": "501-664-5860",
            "fax_number": "501-664-0889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 SHACKLEFORD WEST BLVD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113714",
            "telephone_number": "501-664-5860",
            "fax_number": "501-664-0889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVY",
        "first_name": "LISA",
        "middle_name": "M",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-02",
        "last_updated": "2010-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AR",
            "license": "A01826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.