Anna C Lysiak, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD038516L Issued in PA

Practice address

8001 Roosevelt Blvd
Suite 303
Philadelphia, PA 19152-3038

Phone

(215) 332-9880

Fax

(215) 332-9880

NPI assigned

Mar 23, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215054192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8001 ROOSEVELT BLVD",
            "address_2": "SUITE 303",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191523038",
            "telephone_number": "215-332-9880",
            "fax_number": "215-332-9880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8001 ROOSEVELT BLVD",
            "address_2": "SUITE 303",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191523038",
            "telephone_number": "215-332-9880",
            "fax_number": "215-332-9880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYSIAK",
        "first_name": "ANNA",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD038516L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENIOR PARTNERS",
            "identifier": "07089",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY",
            "identifier": "47998",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "07089",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009532460001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0054209001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maryssa Lyons, MD
• Morgan Elizabeth Lyons, PA-C
• Walker Lyons, MD
• Estelle Davis Lysell
• Andrej Lyshchik, M.D., PH.D.
• Lyta Corporation
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• M & D Behavioral Consultant LLC
• M & M Loving Heart Homecare LLC
• M and a Group Homes

• Internal Medicine Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.