NPIMap

Individual provider Active NPI

Lisa J Green

  • Family Medicine Physician
  • Harvey, IL
National Provider Identifier
1114973062
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036086707 Issued in IL
Practice address
31 W 155TH St
Harvey, IL 60426
Phone
(708) 596-5177
Fax
(708) 339-3583
NPI assigned
May 25, 2006
Last updated
Jul 16, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036086707 IL Primary
General Practice Physician 208D00000X 036086707 IL

Addresses

Primary practice location

31 W 155TH St
Harvey, IL 60426

Mailing address

31 W 155TH St
Harvey, IL 60426-3556
Phone (708) 596-5177

Other identifiers 1

IdentifierTypeStateIssuer
036086707MedicaidIL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060705000026 IL Practitioner - Family Practice 4880606136 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036086707ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Christian Health Center CurrentSince Apr 1, 2000 Accepting new patients
Family Christian Health Center General Practice CurrentSince Apr 1, 2000 Accepting new patients
Special Needs Psychological Services,Inc. Past Accepting new patients
Family Christian Health Center Past Accepting new patients

Locations

713 E 142nd St
Dolton, IL 60419
Phone (708) 596-5177

15620 Wood St
Harvey, IL 60426
Phone (708) 333-3030

31 W 155th St
Harvey, IL 60426
Phone (708) 596-5177

19767 Torrence Ave
Lynwood, IL 60411
Phone (708) 596-5177

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Family Christian Health CenterHarvey, IL, CCN 141002 Federally qualified health center Corporate Officer (100%)
Operational/Managerial Control		 Oct 1, 2001
Oct 1, 2018
Family Christian Health CenterDolton, IL, CCN 141151 Federally qualified health center Corporate Officer
Corporate Director
Operational/Managerial Control		 Apr 1, 2000
Jun 1, 2011
Apr 1, 2000
Family Christian Health CenterLynwood, IL, CCN 781870 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Apr 1, 2000
Apr 1, 2000
Family Christian Health CenterHarvey, IL, CCN 781948 Federally qualified health center Corporate Director (100%)
Operational/Managerial Control (100%)		 Apr 1, 2010
Oct 1, 2018
Family Christian Health CenterHarvey, IL, CCN C41047 Federally qualified health center 5% Or Greater Direct Ownership Interest
Corporate Officer (100%)
Operational/Managerial Control (100%)		 Apr 1, 2025
Apr 1, 2000
Jan 1, 2025

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1114973062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 W 155TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263556",
            "telephone_number": "708-596-5177",
            "fax_number": "708-339-3583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 W 155TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "60426",
            "telephone_number": "708-596-5177",
            "fax_number": "708-339-3583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "LISA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036086707",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IL",
            "license": "036086707",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036086707",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harvey, IL

Sources for this page

Verify at the official NPI Registry.