NPIMap

Organization Active NPI

Lisa Schwab, LLC

  • Professional Counselor
  • Peoria Heights, IL
National Provider Identifier
1194193235
Registry record updated Apr 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
LISA SCHWAB, LLC
Practice address
4211 N Prospect Rd
Peoria Heights, IL 61616-7754
Phone
(309) 691-5502
NPI assigned
Sep 7, 2015
Last updated
Apr 13, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2020

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

Authorized official

Name
Lisa SchwabNPI 1386830156
Title
Owner
Phone
(309) 691-5502

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X NU Primary

Addresses

Primary practice location

4211 N Prospect Rd
Peoria Heights, IL 61616-7754

Mailing address

4211 N Prospect Rd
Peoria Heights, IL 61616-7754
Phone (309) 712-7996

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160923000737 IL Part B Supplier - Clinic/Group Practice 1850688557 Receives reassigned benefits from 8 practitioners
Practice locations: Peoria Heights, IL

National Provider Directory

National Provider Directory

Locations

4211 N Prospect Rd
Peoria Hts, IL 61616
Phone (309) 691-5502

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1441584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586736000000",
    "number": "1194193235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 N PROSPECT RD",
            "city": "PEORIA HEIGHTS",
            "state": "IL",
            "postal_code": "616167754",
            "telephone_number": "309-712-7996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 N PROSPECT RD",
            "city": "PEORIA HEIGHTS",
            "state": "IL",
            "postal_code": "616167754",
            "telephone_number": "309-691-5502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA SCHWAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-07",
        "last_updated": "2020-04-13",
        "certification_date": "2020-04-13",
        "status": "A",
        "authorized_official_last_name": "SCHWAB",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-691-5502"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria Heights, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.