Lisa Marie Rotelli, D. O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

229169 Issued in NY

Practice address

110 Decker Dr Ste 100
Johnstown, NY 12095-2157

Phone

(518) 762-6731

Fax

(518) 762-7135

NPI assigned

Jul 14, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, NY, SD, MT4 enrollments

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 4

Specialty

Pediatric Medicine

Education

New York College of Osteo Medicine of New York Institute of Technology, 1999

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Brookview Medical Associates, PLLC

  • General Practice Physician
  • Bohemia, NY
  • NPI 1871965855
  Medicare reassignment NPD
• Avera St. Luke's

  dba Avera Internal Medicine Aberdeen

  • Internal Medicine Physician
  • Aberdeen, SD
  • NPI 1215100813
  Medicare reassignment
• SCL Health Medical Group-Butte LLC

  • Family Medicine Physician
  • Butte, MT
  • NPI 1477869600
  Medicare reassignment
• Tuba City Regional Health Care Corporation

  dba Tuba City Indian Medical Center

  • General Acute Care Hospital
  • Tuba City, AZ
  • NPI 1548294424

  TX

  Medicare reassignment
• Avera St Lukes

  dba Avera St Lukes Hospital ER CRNA

  • Emergency Medicine Physician
  • Aberdeen, SD
  • NPI 1750271060
  NPD
• Avera St. Lukes

  dba Avera Medical Group Nephrology Aberdeen

  • Nephrology Physician
  • Aberdeen, SD
  • NPI 1477594430
  NPD
• Pine Ridge Indian Health Service Hospital

  dba Wanblee Health Center

  • Clinic/Center
  • Wanblee, SD
  • NPI 1962559518
  NPD (past)

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1215953229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 E STATE ST",
            "city": "GLOVERSVILLE",
            "state": "NY",
            "postal_code": "120781203",
            "telephone_number": "518-762-6731",
            "fax_number": "518-762-7135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 DECKER DR STE 100",
            "city": "JOHNSTOWN",
            "state": "NY",
            "postal_code": "120952157",
            "telephone_number": "518-762-6731",
            "fax_number": "518-762-7135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTELLI",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D. O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "DO-901",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "229169",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "229169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonnie J Reuss, PTA
• Christa Marie Richer, MS, CF-SLP, TSLD
• Rite Aid of New York Inc (Rite Aid Pharmacy 00646)
• Alan Robbins, SOCIAL WORKER
• Tara M Roberts, RPT
• Margaret Anne Rowley, LMSW
• Royal Home Care
• Huseyin Sahin, MD
• Joseph C Salatel
• Randie R Salmon, FNP

• Pediatrics Physician in Johnstown, NY
• Providers in Johnstown, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.