Individual provider Active NPI

Lisa Vidato, MD

  • Anesthesiology Physician
  • Santa Monica, CA
National Provider Identifier
1164535001
Registry record updated Aug 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
G068685 Issued in CA
Practice address
1328 22ND St
Santa Monica, CA 90404-2032
Phone
(310) 681-9996
NPI assigned
Aug 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X G068685 CA Primary

Addresses

Primary practice location

1328 22ND St
Santa Monica, CA 90404-2032

Mailing address

PO Box 60790
Pasadena, CA 91116-6790
Phone (626) 795-6596

Other identifiers 1

IdentifierTypeStateIssuer
00G68650MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041020000665 CA Practitioner - Anesthesiology 2567421753 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Warren Alpert Medical School of Brown University, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bayside Anesthesia Medical GroupGroup PAC ID 2466490560, 47 clinicians

Practice addresses (Care Compare)

1328 22ND St
St Johns Hospital
Santa Monica, CA 90404-2091
Phone (310) 477-2465

Hospital & facility affiliations

  • Saint John'S Health Center Hospital, Santa Monica, CA, CCN 050290

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
68685CAMDPharmacist
G068685CAMDAnesthesiology Physician

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438905600000",
    "number": "1164535001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60790",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911166790",
            "telephone_number": "626-795-6596",
            "fax_number": "626-795-8247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1328 22ND ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042032",
            "telephone_number": "310-681-9996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDATO",
        "first_name": "LISA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2015-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G068685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G68650",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.