Lisa Willis, BGS

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

655 E Main St
Peru, IN 46970-2662

Phone

(765) 472-1931

Fax

(765) 472-1945

NPI assigned

Apr 22, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Lisa Mathis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Four County Comprehensive Mental Health Center, Inc

  • Psychiatric Hospital
  • Peru, IN
  • NPI 1457539751
  NPD (past)

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339977600000",
    "number": "1114192051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 MICHIGAN AVE",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471526",
            "telephone_number": "574-722-5151",
            "fax_number": "574-739-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 E MAIN ST",
            "city": "PERU",
            "state": "IN",
            "postal_code": "469702662",
            "telephone_number": "765-472-1931",
            "fax_number": "765-472-1945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "LISA",
        "credential": "BGS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-22",
        "last_updated": "2012-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "MATHIS",
            "credential": "BGS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Heather Weber, NP
• Steven Wehmeyer, M.D.
• Patricia K Weidner
• Peggy L Wert, COTA
• Zoie Kay Ann Whited I
• Witham Memorial Hospital
• Susan Kay Wolf, LMHC
• Elizabeth E Wolfe
• Zoe Wolfe
• In T Yoon, M.D.

• All providers in Peru, IN
• Case Manager/Care Coordinator in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.

Verify at the official NPI Registry.