Lisa Michelle Matiaco, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

10 Ros Cir
Republic, WA 99166-5002

Phone

(509) 775-3153

Fax

(509) 775-8929

NPI assigned

Nov 1, 2007

Last updated

Mar 21, 2013By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optimal Health of Southern Oregon, LLCGroup PAC ID 7416238241, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Asante Three Rivers Medical Center Hospital, Grants Pass, OR, CCN 380002

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: lisa.matiaco@137795521413124.direct.elationemr.com

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.

• Optimal Health of Southern Oregon, LLC

  • Family Medicine Physician
  • Grants Pass, OR
  • NPI 1902353907
  Medicare reassignment Care Compare group
• Mark Allen Rondeau, M.D.

  • Family Medicine Physician
  • Grants Pass, OR
  • NPI 1518964766
  Medicare reassignment
• Allcare Medical Group LLC

  • Family Medicine Physician
  • Grants Pass, OR
  • NPI 1699360412
  NPD (past)
• Mark Allen Rondeau

  • Family Medicine Physician
  • Grants Pass, OR
  • NPI 1861674780
  NPD (past)

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

• Asante Three Rivers Medical Center, LLC

  • General Acute Care Hospital
  • Grants Pass, OR
  • NPI 1801891809
  Care Compare affiliation

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

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363824000000",
    "number": "1154500536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 ROS CIR",
            "city": "REPUBLIC",
            "state": "WA",
            "postal_code": "991665002",
            "telephone_number": "509-775-3153",
            "fax_number": "509-775-8929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 ROS CIR",
            "city": "REPUBLIC",
            "state": "WA",
            "postal_code": "991665002",
            "telephone_number": "509-775-3153",
            "fax_number": "509-775-8929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATIACO",
        "first_name": "LISA",
        "middle_name": "MICHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-01",
        "last_updated": "2013-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janelle Kay Klein, ARNP
• Hannah Konen, DPT
• David James Kopp, MA
• Kelsey Krueger
• Cassandra N Lembcke
• Brandon Melester, PT
• Mindfulness and Motivation LLC
• Melissa Mitchell, DNP, AGPCNP-BC
• William A Pellow X, OD
• Republic Dental Clinic

• Physician Assistant in Republic, WA
• Providers in Republic, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.