Individual provider Active NPI

Lisa M Corley, PA-C

  • Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1194965384
Registry record updated Sep 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0009459 Issued in CO
Practice address
600 S 21St St
Colorado Springs, CO 80904-3762
Phone
(719) 473-1552
NPI assigned
Feb 27, 2009
Last updated
Sep 24, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.0009459 CO Primary

Addresses

Primary practice location

600 S 21St St
Colorado Springs, CO 80904-3762

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 579-3203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20090326000342 TX Practitioner - Physician Assistant 7214094820 Reassigns benefits to 2 organizations
I20260203002004 CO Practitioner - Physician Assistant 7214094820 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

700 W US Hwy 24
Woodland Park, CO 80863-8975
Phone (719) 687-6022

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.0009459COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Optumcare Colorado Medical Group LLC CurrentSince Dec 27, 2025 Accepting new patients
Optumcare Colorado Medical Group LLC Past Accepting new patients
Bir JV LLP Past Accepting new patients
Domicilliary Service LLC Past Accepting new patients

Locations

1625 Medical Center Pt
Ste 290
Colorado Springs, CO 80907
Phone (719) 635-5148

700 W US Highway 24
Woodland Park, CO 80863
Phone (719) 687-6022

Organizations & group practices 6

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.

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": "1235692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790208000000",
    "number": "1194965384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S 21ST ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809043762",
            "telephone_number": "719-473-1552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORLEY",
        "first_name": "LISA",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-27",
        "last_updated": "2026-09-24",
        "certification_date": "2026-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0009459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.