Active NPI
Lisa G. Matthews, RD, LDN
- Registered Dietitian
- Libertyville, IL
National Provider Identifier
1073629911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 200 W Golf Rd
Libertyville, IL 60048-3234 - Phone
- (847) 990-5770
- NPI assigned
- Aug 22, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | IL | Primary |
Addresses
Primary practice location
200 W Golf Rd
Libertyville, IL 60048-3234
Mailing address
197 Acorn LN
Libertyville, IL 60048-2157
Phone (847) 816-4687
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.001352 | IL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ad Medical Supply, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Durable Medical Equipment & Medical Supplies
- Chicago, IL
- NPI 1629015904
Dietitian, Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073629911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "197 ACORN LN",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "600482157",
"telephone_number": "847-816-4687"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 W GOLF RD",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "600483234",
"telephone_number": "847-990-5770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTHEWS",
"first_name": "LISA",
"middle_name": "G.",
"credential": "RD, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Libertyville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.