NPIMap

Individual provider Active NPI

Lisa Marie Peterson, MD

  • Family Medicine Physician
  • Lincoln, NE
National Provider Identifier
1073682993
Registry record updated Jul 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17254 Issued in NE
Practice address
4701 Normal Blvd
Lincoln, NE 68506-5563
Phone
(402) 488-5050
Fax
(402) 488-5001
NPI assigned
Nov 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 17254 NE Primary

Addresses

Primary practice location

4701 Normal Blvd
Lincoln, NE 68506-5563

Mailing address

4701 Normal Blvd
Lincoln, NE 68506-5563
Phone (402) 488-5050

Other identifiers 1

IdentifierTypeStateIssuer
100263068-00MedicaidNE

Other names 1

  • Lisa Marie Sandberg Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100526000583 NE Practitioner - Family Practice 4587793757 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nebraska College of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Capital Medical Clinic LLPGroup PAC ID 5799925475, 7 clinicians

Practice addresses (Care Compare)

4701 Normal Blvd
Lincoln, NE 68506-5563
Phone (402) 488-5050

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions12
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Capital Medical Clinic LLP Family Medicine CurrentSince May 1, 2013 Accepting new patients

Locations

4701 Normal Blvd
Lincoln, NE 68506
Phone (402) 484-5656

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.

Hospital & facility affiliations 11

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": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374796800000",
    "number": "1073682993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 NORMAL BLVD",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685065563",
            "telephone_number": "402-488-5050",
            "fax_number": "402-488-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 NORMAL BLVD",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685065563",
            "telephone_number": "402-488-5050",
            "fax_number": "402-488-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2013-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "17254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100263068-00",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "SANDBERG",
            "middle_name": "MARIE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lincoln, NE

Sources for this page

Verify at the official NPI Registry.