Individual provider Active NPI

Lisa McKay Buckmiller, MD

  • Pediatric Otolaryngology Physician
  • Fort Worth, TX
National Provider Identifier
1033120399
Registry record updated Jan 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Otolaryngology PhysicianTaxonomy code 207YP0228X
License
P3862 Issued in TX
Practice address
901 7TH Ave
Fort Worth, TX 76104-2722
Phone
(682) 885-6850
Fax
(682) 885-6799
NPI assigned
Aug 11, 2006
Last updated
Jan 10, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Otolaryngology Physician 207YP0228X E2549 AR
Pediatric Otolaryngology Physician 207YP0228X P3862 TX Primary

Addresses

Primary practice location

901 7TH Ave
Fort Worth, TX 76104-2722

Mailing address

PO Box 733784
Dallas, TX 75373-3784
Phone (682) 885-8483

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lbuckmiller173882@CookChildrens.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20130202000000 TX Practitioner - Otolaryngology 7911917752 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of California, Irvine, California College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cook Childrens Physician NetworkGroup PAC ID 7719884584, 307 clinicians

Practice addresses (Care Compare)

901 7TH Ave
Fort Worth, TX 76104-2722
Phone (682) 885-6850

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E2549ARMDPediatric Otolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cook Children's Physician Network CurrentSince Jan 10, 2022 Accepting new patients
Baylor College of Medicine CurrentSince Nov 18, 2013 Accepting new patients
Cook Children's Physician Network CurrentSince Jan 10, 2022 Accepting new patients
Santa Rosa Family Health Center Past Accepting new patients
Cook Children's Medical Center Past Accepting new patients

Locations

801 7th Ave
Ft Worth, TX 76104
Phone (682) 885-4054

901 7th Ave
Ft Worth, TX 76104
Phone (682) 885-1050

333 N Santa Rosa
San Antonio, TX 78207
Phone (210) 704-2190

136 El Chico Trl
Ste 102
Willow Park, TX 76087
Phone (817) 441-5412

Interoperability endpoints

  • Direct secure messaging: lbuckmiller173882@cookchildrens.direct-ci.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1033120399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-8483",
            "fax_number": "682-885-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 7TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042722",
            "telephone_number": "682-885-6850",
            "fax_number": "682-885-6799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKMILLER",
        "first_name": "LISA",
        "middle_name": "MCKAY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YP0228X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "AR",
            "license": "E2549",
            "primary": false
        },
        {
            "code": "207YP0228X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "TX",
            "license": "P3862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lbuckmiller173882@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "901 7th Ave",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761042722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.