Lisa Ann Mazzocut Siino, DO

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

DO211433 Issued in OR

Practice address

15 82ND Dr Ste 100
Gladstone, OR 97027-2550

Phone

(510) 316-4255

NPI assigned

Apr 13, 2016

Last updated

Jan 17, 2023By the provider in NPPES

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 names 1

• Lisa Ann Mazzocut Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Sep 18, 2024 through Sep 18, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1460505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1245684489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 W CHESTNUT AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023805",
            "telephone_number": "510-316-4255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 82ND DR STE 100",
            "city": "GLADSTONE",
            "state": "OR",
            "postal_code": "970272550",
            "telephone_number": "510-316-4255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 University Pkwy",
            "address_purpose": "LOCATION",
            "city": "Yakima",
            "state": "WA",
            "postal_code": "989019539",
            "country_code": "US",
            "telephone_number": "510-316-4255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIINO",
        "first_name": "LISA",
        "middle_name": "ANN MAZZOCUT",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-13",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "OR",
            "license": "DO211433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "MAZZOCUT",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jason Schlenker, DC
• Kimberly H Schlievert, PH.D. IN PSYCHOLOGY
• Peggy J Seiler
• Shannon L Sexton, RN
• Tiara Sharpes
• Skylar Marie Skelton, LMT
• Erin Taylor Sloan, CSWA
• Morgan Sloan, FNP-C
• Diane Y. Smith
• Elizabeth Daffer Smith, PHD, LCSW

• Neuromusculoskeletal Medicine & OMM Physician in Gladstone, OR
• Providers in Gladstone, OR by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.