Individual provider Active NPI

Lisa Marie Mulligan, M.D.

  • Otolaryngology Physician
  • Edmonds, WA
National Provider Identifier
1093891103
Registry record updated May 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD00037369 Issued in WA
Practice address
21911 76TH Ave W Ste 211
Edmonds, WA 98026-7918
Phone
(425) 775-6651
Fax
(425) 670-6718
NPI assigned
Oct 31, 2006
Last updated
May 2, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD00037369 WA Primary

Addresses

Primary practice location

21911 76TH Ave W Ste 211
Edmonds, WA 98026-7918

Mailing address

21911 76TH Ave W Ste 211
Edmonds, WA 98026-7918
Phone (425) 775-6651

Other practice location 1

13020 Meridian Ave S Fl 2
Everett, WA 98208-6468
Phone (425) 775-6651

Other practice location 2

515 Minor Ave Ste 140
Seattle, WA 98104-2138
Phone (425) 775-6651

Other identifiers 1

IdentifierTypeStateIssuer
2140095MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060407000223 WA Practitioner - Otolaryngology 3577572288 Reassigns benefits to 1 organization
Practice locations: Issaquah, WA

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Wayne State University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

21911 76TH Ave W
Suite 211
Edmonds, WA 98026-7918
Phone (253) 770-9000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc P S Current Accepting new patients
Proliance Surgeons Inc P S CurrentSince May 1, 2023 Accepting new patients
Proliance Surgeons, Inc., P.S. Otolaryngology CurrentSince May 1, 2023 Accepting new patients
Proliance Surgeons Inc., P.S. Past Accepting new patients

Locations

21911 76th Ave W
Ste 211
Edmonds, WA 98026
Phone (253) 770-9000

13020 Meridian Ave S
Fl 2
Everett, WA 98208
Phone (425) 357-3700

510 8th Ave NE
Ste 200
Issaquah, WA 98029
Phone (425) 392-3030

515 Minor Ave
Ste 140
Seattle, WA 98104
Phone (206) 682-6103

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

Interoperability endpoints

  • Direct secure messaging: lisa.mulligan.p46@direct.proliance.nextgenshare.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682985600000",
    "number": "1093891103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21911 76TH AVE W STE 211",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267918",
            "telephone_number": "425-775-6651",
            "fax_number": "425-670-6718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21911 76TH AVE W STE 211",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267918",
            "telephone_number": "425-775-6651",
            "fax_number": "425-670-6718"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13020 Meridian Ave S Fl 2",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982086468",
            "country_code": "US",
            "telephone_number": "425-775-6651",
            "fax_number": "425-670-6718",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 Minor Ave Ste 140",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981042138",
            "country_code": "US",
            "telephone_number": "425-775-6651",
            "fax_number": "425-670-6718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MULLIGAN",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-31",
        "last_updated": "2023-05-02",
        "certification_date": "2023-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "MD00037369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2140095",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmonds, WA

Sources for this page

Verify at the official NPI Registry.