Active NPI
Drlullaby, LLC
- Clinic/Center
- McComb, MS
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- DRLULLABY, LLC
- Practice address
- 1102A Delaware Ave
McComb, MS 39648-3830 - Phone
- (844) 475-3379
- NPI assigned
- Jan 26, 2023
- Last updated
- Mar 21, 2023
- Organization subpart
- Yes
- Parent organization
- DRLULLABY, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lisa Ann Medalie
- Title
- Ceo
- Phone
- (619) 997-5759
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Primary | ||
| Cognitive & Behavioral Psychologist | 103TB0200X |
Addresses
Primary practice location
1102A Delaware Ave
McComb, MS 39648-3830
Mailing address
1440 W Taylor St # 556
Chicago, IL 60607-4623
Phone (844) 475-3379
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230323002675 | MS | Part B Supplier - Clinic/Group Practice | 9931507290 | Practice locations: McComb, MS |
Other NPIs with the same Medicare PAC ID 6
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Part of
- Drlullaby LLC
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Clinical Neuropsychologist
- Evanston, IL
- NPI 1609175744
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674691200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1679356800000",
"number": "1063128635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1440 W TAYLOR ST # 556",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606074623",
"telephone_number": "844-475-3379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1102A DELAWARE AVE",
"city": "MCCOMB",
"state": "MS",
"postal_code": "396483830",
"telephone_number": "844-475-3379"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DRLULLABY, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "DRLULLABY, LLC",
"enumeration_date": "2023-01-26",
"last_updated": "2023-03-21",
"certification_date": "2023-03-21",
"status": "A",
"authorized_official_last_name": "MEDALIE",
"authorized_official_first_name": "LISA",
"authorized_official_middle_name": "ANN",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "619-997-5759"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McComb, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; 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.