NPIMap

Individual provider Active NPI

Lisa Ann Kerich, PA

  • Physician Assistant
  • Colleyville, TX
National Provider Identifier
1316977234
Registry record updated Dec 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA00181 Issued in TX
Practice address
5204 Colleyville Boulevard
Colleyville, TX 76034
Phone
(817) 369-3300
Fax
(817) 581-6127
NPI assigned
Jul 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA00181 TX Primary

Addresses

Primary practice location

5204 Colleyville Boulevard
Colleyville, TX 76034

Mailing address

5204 Colleyville Boulevard
Colleyville, TX 76034
Phone (817) 369-3300

Other identifiers 4

IdentifierTypeStateIssuer
1023145OtherTXNCCPA
803N51OtherTXBCBS
205392801MedicaidTX
P00956844OtherTXRAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070130000073 TX Practitioner - Physician Assistant 2668473935 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Century Integrated Partners, IncGroup PAC ID 6406151703, 330 clinicians

Practice addresses (Care Compare)

3500 Gaston Ave
Dallas, TX 75246-2017
Phone (214) 820-0111

Hospital & facility affiliations

  • Cherokee Nation W W Hastings Indian Hospital Hospital, Tahlequah, OK, CCN 370171

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA00181TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Dec 23, 2024 Accepting new patients
Healthtexas Provider Network CurrentSince Dec 23, 2024 Accepting new patients
Cherokee Nation Past Accepting new patients
WLS Surgical Associates PA Past Accepting new patients
Rockwall Cardio-Pulmonary Services Inc Past Accepting new patients
Dallas Emergency Physicians PLLC Past Accepting new patients
Exceptional Garland Medical Plaza Imaging LLC PastSince Nov 1, 2019 Accepting new patients

Locations

5408 Colleyville Blvd
Colleyville, TX 76034
Phone (817) 498-9920

301 N Washington Ave
Dallas, TX 75246
Phone (469) 800-8330

4001 Worth St
Dallas, TX 75246
Phone (214) 828-1745

9101 N Central Expy
Ste 370
Dallas, TX 75231
Phone (214) 820-4397

3500 Gaston Ave
Dallas, TX 75246

821 N Coleman St
Ste 100
Prosper, TX 75078
Phone (469) 800-5200

Interoperability endpoints

  • Direct secure messaging: lkerich1386293@direct.sw.org

Organizations & group practices 9

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545264000000",
    "number": "1316977234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5204 COLLEYVILLE BOULEVARD",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "76034",
            "telephone_number": "817-369-3300",
            "fax_number": "817-581-6127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5204 COLLEYVILLE BOULEVARD",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "76034",
            "telephone_number": "817-369-3300",
            "fax_number": "817-581-6127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERICH",
        "first_name": "LISA",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-04",
        "last_updated": "2018-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA00181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1023145",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "803N51",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205392801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00956844",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colleyville, TX

Sources for this page

Verify at the official NPI Registry.