NPIMap

Organization Active NPI

Lighthouse Family Medicine, PLLC

Doing business as Lisa C. Nelson, MD

  • Medical Specialty Clinic/Center
  • Washington, NC
National Provider Identifier
1093967408
Registry record updated Oct 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
207-00955 Issued in NC
Legal business name
LIGHTHOUSE FAMILY MEDICINE, PLLC
Doing business as
Lisa C. Nelson, MD
Practice address
1005 Brown St
Washington, NC 27889-4670
Phone
(252) 948-1393
NPI assigned
Oct 16, 2008
Last updated
Oct 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2008

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

Authorized official

Name
Dr. Lisa Carraway Nelson, MDNPI 1780880054
Title
Owner
Phone
(252) 948-1393

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 207-00955 NC Primary

Addresses

Primary practice location

1005 Brown St
Washington, NC 27889-4670

Mailing address

1005 Brown St
Washington, NC 27889-4670
Phone (252) 948-1393

Other identifiers 2

IdentifierTypeStateIssuer
146HHOtherNCBLUE CROSS
5908673MedicaidNC

Other names 1

  • Lisa C. Nelson, MD Doing business as

National Provider Directory

National Provider Directory

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224115200000",
    "number": "1093967408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 BROWN ST",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278894670",
            "telephone_number": "252-948-1393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 BROWN ST",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278894670",
            "telephone_number": "252-948-1393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE FAMILY MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-16",
        "last_updated": "2008-10-16",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "CARRAWAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-948-1393",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NC",
            "license": "207-00955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "146HH",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5908673",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lisa C. Nelson, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.