Lisa Ann Provost, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

COA.04992-NA Issued in OH

Practice address

401 Matthew St
Marietta, OH 45750-1635

Phone

(740) 376-1994

Fax

(740) 376-1940

NPI assigned

Mar 2, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• Lisa Ann Wallace Former name

Medicare fee-for-service enrollment

Enrolled in KY, OH, WV, SC4 enrollments

Enrollment records 4

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

McLeod Physician Associates IIGroup PAC ID 8224031307, 541 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• McLeod Loris Hospital Hospital, Loris, SC, CCN 420105

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

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.

• McLeod Physician Associates II

  • Family Medicine Physician
  • Florence, SC
  • NPI 1801990494
  Medicare reassignment Care Compare group NPD
• Oasis Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Ironton, OH
  • NPI 1720470792

  Nurse Anesthetist, Certified Registered, WV

  Medicare reassignment NPD
• Environ Anesthesia, LLC.

  • Anesthesiology Physician
  • Lexington, KY
  • NPI 1831438092

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Medstream Anesthesia PLLC

  • Anesthesiology Physician
  • Richardson, TX
  • NPI 1649616160

  Nurse Anesthetist, Certified Registered, SC

  Medicare reassignment NPD
• Riverside Anesthesia, PSC

  • Anesthesiology Physician
  • Ashland, KY
  • NPI 1578946596
  Medicare reassignment
• McLeod Physician Associates II

  • Orthopaedic Surgery Physician
  • Florence, SC
  • NPI 1922555739
  NPD
• Charleston Surgical Hospital Healthcare Group, PLLC

  • Surgery Physician
  • Charleston, WV
  • NPI 1285131144
  NPD (past)
• Day Surgery Limited Liability

  • Ambulatory Surgical Clinic/Center
  • Charleston, WV
  • NPI 1730296997
  NPD (past)
• Sleepers Anesthesia Services, PLLC

  • Certified Registered Nurse Anesthetist
  • Danville, KY
  • NPI 1699225631

  Nurse Anesthetist, Certified Registered

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• McLeod Loris Seacoast Hospital

  • General Acute Care Hospital
  • Loris, SC
  • NPI 1306123344
  Care Compare affiliation

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513123200000",
    "number": "1235106840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 449",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457500449",
            "telephone_number": "740-374-4500",
            "fax_number": "740-374-5887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 MATTHEW ST",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457501635",
            "telephone_number": "740-376-1994",
            "fax_number": "740-376-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVOST",
        "first_name": "LISA",
        "middle_name": "ANN",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-02",
        "last_updated": "2017-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3485A",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "COA.04992-NA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0069080000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0282617",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74472408",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SHIELD",
            "identifier": "000000339679",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "WALLACE",
            "middle_name": "ANN",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Haley Pressley
• Private Healthcare Facilities
• Procare Vision Center, LLC
• Gabrielle Prokop, M.D.
• Andrew Peter Proto
• Young-Mi Pruden, M.D.
• Alexander Nathan Pyles, CDCA
• Quality Care Associates Urgent Care and Wellness Center, LLC
• Quality Care Associates Urgent Care and Wellness Center, LLC
• Quality of Life Home Care, LTD

• Certified Registered Nurse Anesthetist in Marietta, OH
• Providers in Marietta, OH by specialty
• Certified Registered Nurse Anesthetist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.