Active NPI
Lisa A Diponio, MD
- Spinal Cord Injury Medicine Physician
- Ann Arbor, MI
National Provider Identifier
1093897977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Spinal Cord Injury Medicine Physician
- License
- 4301066405
- Practice address
- 325 East Eisenhower Pkwy
Suite 100
Ann Arbor, MI 48108-3364 - Phone
- (734) 936-7175
- NPI assigned
- Oct 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Spinal Cord Injury Medicine Physician | 2081P0004X | 4301066405 | MI | Primary |
| Physical Medicine & Rehabilitation Physician | 208100000X | 4301066405 | MI |
Addresses
Primary practice location
325 East Eisenhower Pkwy
Suite 100
Ann Arbor, MI 48108-3364
Mailing address
3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4138413 | Medicaid | MI |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301066405 | MI | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regents of the University of Michigan | 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.
-
- General Acute Care Hospital
- Ann Arbor, MI
- NPI 1003878539
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330560000000",
"number": "1093897977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3621 S STATE ST",
"address_2": "700 KMS PLACE",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "48108",
"telephone_number": "734-936-2047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 EAST EISENHOWER PKWY",
"address_2": "SUITE 100",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481083364",
"telephone_number": "734-936-7175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIPONIO",
"first_name": "LISA",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-19",
"last_updated": "2012-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "2081P0004X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine",
"state": "MI",
"license": "4301066405",
"primary": true
},
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "MI",
"license": "4301066405",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4138413",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.