Lisa A Rivera, NP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Suffolk, VA
NPI 1225200066 · NPPES record last updated Jan 4, 2013
Key facts
- NPI
- 1225200066
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 0024167690 (VA)
- Practice address
- 1000 Commercial LN
Suffolk, VA 23434-8148 - Phone
- (757) 942-1025
- Fax
- (757) 925-3504
- NPI assigned
- Apr 1, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Western Tidewater Community Mental
Practice addresses (Care Compare)
7025 Harbour View Blvd
Suite 119
Suffolk, VA 23435-2762
Phone (757) 966-2805
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081219000490 | VA | Practitioner - Nurse Practitioner | 6305908674 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0024167690 | VA | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western Tidewater Community Mental | Current |
Accepting new patients |
Locations
200 E 2nd Ave
Franklin, VA 23851
Phone (757) 562-2208
1913 S Church St
Ste 2
Smithfield, VA 23430
Phone (757) 357-7458
1801 S Church St
Ste 6
Smithfield, VA 23430
135 S Saratoga St
Suffolk, VA 23434
Phone (757) 925-1981
5268 Godwin Blvd
Suffolk, VA 23434
Phone (757) 255-7117
1000 Commercial Ln
Suffolk, VA 23434
Phone (757) 925-2484
157 N Main St
Ste D
Suffolk, VA 23434
Phone (757) 925-2484
7025 Harbour View Blvd
Ste 119
Suffolk, VA 23435
Phone (757) 670-7471
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 0024167690 | VA | Yes |
Addresses
Primary practice location
1000 Commercial LN
Suffolk, VA 23434-8148
Mailing address
5268 Godwin Blvd
Suffolk, VA 23434-8114
Phone (757) 255-7117
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004945310 | Medicaid | VA |
Other providers in Suffolk, VA
- Jessica Lynn Rinehart
- Robert Sean Rinehart
- Rite Aid of Virginia Inc
- Rite Aid of Virginia Inc
- Virginia Dougherty Rivenbark
- Karen Lynne Rivers
- Riverside Hospital, Inc
- Michelle O Rizzatti
- RNJ Group, LLC
- Arthur Roberson
All providers in Suffolk, VA · Psychiatric/Mental Health Nurse Practitioner in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.