NPIMap

Individual provider Active NPI

Lisa Weider Klanke, MD

  • Pediatrics Physician
  • Dayton, OH
National Provider Identifier
1184840043
Registry record updated Jul 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
35.091257 Issued in OH
Practice address
6551 Centerville Business Pkwy Ste 110
Dayton, OH 45459-2696
Phone
(937) 291-6850
Fax
(937) 291-6896
NPI assigned
Apr 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 57-010522 OH
Pediatrics Physician 208000000X 35.091257 OH Primary

Addresses

Primary practice location

6551 Centerville Business Pkwy Ste 110
Dayton, OH 45459-2696

Mailing address

25 Merchant Street
Suite 220
Cincinnati, OH 45246-3740
Phone (513) 533-6507

Other identifiers 1

IdentifierTypeStateIssuer
2896086MedicaidOH

Other names 1

  • Dr. Lisa Kaye Weider Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35.091257OHMDPediatrics Physician
57-010522OHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Medical Center Pediatrics Past Accepting new patients
Muddy Creek Pediatrics LLC Pediatrics Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595376000000",
    "number": "1184840043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 MERCHANT STREET",
            "address_2": "SUITE 220",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452463740",
            "telephone_number": "513-533-6507",
            "fax_number": "513-645-9767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6551 CENTERVILLE BUSINESS PKWY STE 110",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454592696",
            "telephone_number": "937-291-6850",
            "fax_number": "937-291-6896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLANKE",
        "first_name": "LISA",
        "middle_name": "WEIDER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-18",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "57-010522",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.091257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2896086",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "WEIDER",
            "middle_name": "KAYE",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dayton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.