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

Sex

Female

Sole proprietor

No

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.

• Optimal Health of Southern Oregon, LLC

  • Family Medicine Physician
  • Grants Pass, OR
  • NPI 1902353907

  OR

  Medicare reassignment Care Compare group
• Mark Allen Rondeau, M.D.

  • Family Medicine Physician
  • Grants Pass, OR
  • NPI 1518964766

  OR

  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

  Hospital

  Care Compare affiliation

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optimal Health of Southern Oregon, LLC 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

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

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 21, 2013.

{
    "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": []
}

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• Hannah Konen, DPT
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• Cassandra N Lembcke
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• Melissa Mitchell, DNP, AGPCNP-BC
• William A Pellow X, OD
• Republic Dental Clinic
• Republic School District

• All providers in Republic, WA
• 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.