NPIMap

Individual provider Active NPI

Lisa M. Boggs, FNP-C

  • Family Nurse Practitioner
  • Lebanon, MO
National Provider Identifier
1124403944
Registry record updated Nov 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2015023431 Issued in MO
Practice address
120 Hospital Dr
Suite 300
Lebanon, MO 65536-9238
Phone
(417) 533-6746
Fax
(417) 533-6722
NPI assigned
Jul 22, 2015
Last updated
Nov 10, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2015023431 MO Primary

Addresses

Primary practice location

120 Hospital Dr
Suite 300
Lebanon, MO 65536-9238

Mailing address

PO Box 505164
Saint Louis, MO 63150-5164
Phone (417) 829-4620

Other identifiers 1

IdentifierTypeStateIssuer
1124403944MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20150911000315 MO Practitioner - Nurse Practitioner 1951618792 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

1605 Martin Springs Dr
Rolla, MO 65401-2980

904 S Pine St
MC Family Medicine Richland
Richland, MO 65556-7393
Phone (573) 765-2956

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2015023431MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Aug 5, 2015 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Feb 11, 2018 Accepting new patients
Mercy Clinic Springfield Communities Family CurrentSince Aug 5, 2015 Accepting new patients

Locations

120 Hospital Dr
Ste 300
Lebanon, MO 65536
Phone (417) 533-6746

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

Interoperability endpoints

  • Direct secure messaging: lboggs523266@directc.mercy.net

Organizations & group practices 3

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1437523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447113600000",
    "number": "1124403944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 505164",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631505164",
            "telephone_number": "417-829-4620",
            "fax_number": "417-829-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 HOSPITAL DR",
            "address_2": "SUITE 300",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655369238",
            "telephone_number": "417-533-6746",
            "fax_number": "417-533-6722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGGS",
        "first_name": "LISA",
        "middle_name": "M.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-22",
        "last_updated": "2015-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2015023431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124403944",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, MO

Sources for this page

Verify at the official NPI Registry.