NPIMap

Organization Active NPI

Lisa a. Davis, M.D., P.a.

  • Internal Medicine Physician
  • San Antonio, TX
National Provider Identifier
1053505875
Registry record updated Feb 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
H1945 Issued in TX
Legal business name
LISA A. DAVIS, M.D., P.A.
Practice address
414 Navarro St
Suite 1023
San Antonio, TX 78205-2516
Phone
(210) 223-3246
Fax
(210) 223-1816
NPI assigned
Sep 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2008

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

Authorized official

Name
Dr. Lisa A Davis, M.D.NPI 1285648808
Title
Owner
Phone
(210) 223-3246

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X H1945 TX Primary

Addresses

Primary practice location

414 Navarro St
Suite 1023
San Antonio, TX 78205-2516

Mailing address

414 Navarro St
Suite 1023
San Antonio, TX 78205-2516
Phone (210) 223-3246

Other identifiers 3

IdentifierTypeStateIssuer
0096GWOtherTXBCBS
CJ5947OtherTXRAILROAD MEDICARE PTAN
153269901MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050610000856 TX Part B Supplier - Clinic/Group Practice 0749224715 Receives reassigned benefits from 4 practitioners
Practice locations: San Antonio, TX

National Provider Directory

National Provider Directory

Locations

414 Navarro St
Ste 1023
San Antonio, TX 78205
Phone (210) 223-2324

520 Camden St
San Antonio, TX 78215
Phone (210) 223-1816

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204070400000",
    "number": "1053505875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 NAVARRO ST",
            "address_2": "SUITE 1023",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782052516",
            "telephone_number": "210-223-3246",
            "fax_number": "210-223-1816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 NAVARRO ST",
            "address_2": "SUITE 1023",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782052516",
            "telephone_number": "210-223-3246",
            "fax_number": "210-223-1816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA A. DAVIS, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2008-02-27",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-223-3246",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "H1945",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0096GW",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "CJ5947",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "153269901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.