Individual provider Active NPI

Lisa Anne Dickinson, FNP

  • Family Nurse Practitioner
  • Washington, MO
National Provider Identifier
1053498451
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN117227 Issued in MO
Practice address
851 E 5TH St
Washington, MO 63090-3135
Phone
(636) 239-1101
NPI assigned
Nov 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN117227 MO Primary

Addresses

Primary practice location

851 E 5TH St
Washington, MO 63090-3135

Mailing address

1647 Oak Parc
Union, MO 63084-3608
Phone (636) 239-1101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20150116000471 MO Practitioner - Nurse Practitioner 3375867559 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic East CommunitiesGroup PAC ID 7214827922, 573 clinicians

Practice addresses (Care Compare)

851 E 5TH St
Suite 328
Washington, MO 63090-3130
Phone (636) 239-1101

Hospital & facility affiliations

  • Mercy Hospital Washington Hospital, Washington, MO, CCN 260052
  • Mercy Hospital St Louis Hospital, Saint Louis, MO, CCN 260020

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN117227MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities CurrentSince Dec 8, 2014 Accepting new patients
Mercy Clinic East Communities Family Current Accepting new patients
Mercy Clinic East Communities CurrentSince Dec 8, 2014 Accepting new patients

Locations

621 S New Ballas Rd
Ste 189A
Saint Louis, MO 63141
Phone (314) 251-6335

851 E 5th St
Ste 328
Washington, MO 63090
Phone (636) 239-1101

Interoperability endpoints

  • Direct secure messaging: ldickinson1046@directc.mercy.net

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053498451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1647 OAK PARC",
            "city": "UNION",
            "state": "MO",
            "postal_code": "630843608",
            "telephone_number": "636-239-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 E 5TH ST",
            "city": "WASHINGTON",
            "state": "MO",
            "postal_code": "630903135",
            "telephone_number": "636-239-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKINSON",
        "first_name": "LISA",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "RN117227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, MO

Sources for this page

Verify at the official NPI Registry.