Lisa Ruth McLean, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601008938 Issued in MI

Practice address

17500 Federal Dr Ste 750
Allen Park, MI 48101-3656

Phone

(313) 982-1370

Fax

(313) 982-1376

NPI assigned

Oct 3, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Lisa Ruth Cocco Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: lcocco@concentra.com

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.

• Carbon Health Primary Care of California PC

  • Multi-Specialty Clinic/Center
  • Berkeley, CA
  • NPI 1972057990
  NPD (past)

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

{
    "created_epoch": "1475452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1114476140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17500 FEDERAL DR STE 750",
            "city": "ALLEN PARK",
            "state": "MI",
            "postal_code": "481013656",
            "telephone_number": "313-982-1370",
            "fax_number": "313-982-1376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17500 FEDERAL DR STE 750",
            "city": "ALLEN PARK",
            "state": "MI",
            "postal_code": "481013656",
            "telephone_number": "313-982-1370",
            "fax_number": "313-982-1376"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 Industrial rd",
            "address_purpose": "LOCATION",
            "city": "San Carlos",
            "state": "CA",
            "postal_code": "940702603",
            "country_code": "US",
            "telephone_number": "650-596-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14911 National Ave",
            "address_purpose": "LOCATION",
            "city": "Los Gatos",
            "state": "CA",
            "postal_code": "950322632",
            "country_code": "US",
            "telephone_number": "408-358-3511",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1998 Market St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "94102",
            "country_code": "US",
            "telephone_number": "415-792-4060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCLEAN",
        "first_name": "LISA",
        "middle_name": "RUTH",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-03",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "MI",
            "license": "5601008938",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA53731",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601008938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "LCocco@concentra.com",
            "affiliation": "N",
            "endpointDescription": "Secure business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "17500 Federal Dr Ste 750",
            "city": "Allen Park",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481013656",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "COCCO",
            "middle_name": "RUTH",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Medical Physician Assistant in Allen Park, MI
• Providers in Allen Park, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2021; 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.