Active NPI
Lisa M Sershon, PA-C
- Physician Assistant
- Grafton, WI
National Provider Identifier
1245514702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2854-23
- Practice address
- 975 Port Washington Rd
Grafton, WI 53024-9201 - Phone
- (262) 329-1000
- Fax
- (262) 329-1001
- NPI assigned
- Oct 3, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2854-23 | WI | Primary |
Addresses
Primary practice location
975 Port Washington Rd
Grafton, WI 53024-9201
Mailing address
3301 W Forest Home Ave
Milwaukee, WI 53215-2843
Phone (262) 329-1000
Other practice location 1
3237 S 16th St
Milwaukee, WI 53215-4526
Phone (414) 769-4040
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100017857 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Organizations & group practices 1
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.
-
- Neurology Physician
- Milwaukee, WI
- NPI 1649223041
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609718400000",
"number": "1245514702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3301 W FOREST HOME AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532152843",
"telephone_number": "262-329-1000",
"fax_number": "262-329-1001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "975 PORT WASHINGTON RD",
"city": "GRAFTON",
"state": "WI",
"postal_code": "530249201",
"telephone_number": "262-329-1000",
"fax_number": "262-329-1001"
}
],
"practiceLocations": [
{
"address_1": "3237 S 16th St",
"address_purpose": "LOCATION",
"city": "Milwaukee",
"state": "WI",
"postal_code": "532154526",
"country_code": "US",
"telephone_number": "414-769-4040",
"fax_number": "414-769-4041",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SERSHON",
"first_name": "LISA",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-03",
"last_updated": "2021-01-04",
"certification_date": "2021-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "2854-23",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100017857",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grafton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.