NPIMap

Individual provider Active NPI

Lisa Raacke, MD

  • Internal Medicine Physician
  • Hackensack, NJ
National Provider Identifier
1346215126
Registry record updated Feb 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA08360000 Issued in NJ
Practice address
20 Prospect Ave Ste 613
Hackensack, NJ 07601-1962
Phone
(201) 336-8111
Fax
(201) 336-8445
NPI assigned
Feb 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 1677921 NY
Internal Medicine Physician 207R00000X 25MA08360000 NJ Primary

Addresses

Primary practice location

20 Prospect Ave Ste 613
Hackensack, NJ 07601-1962

Mailing address

20 Prospect Ave Ste 613
Hackensack, NJ 07601-1962
Phone (201) 336-8111

Other identifiers 2

IdentifierTypeStateIssuer
01590596MedicaidNY
110166628OtherNYRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090115000225 NJ Practitioner - Internal Medicine 0749343887 Reassigns benefits to 2 organizations
I20140731002207 NY Practitioner - Emergency Medicine 0749343887 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Georgetown University School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hackensack Meridian Health Medical Group - Primary Care PCGroup PAC ID 7911003330, 364 clinicians

Practice addresses (Care Compare)

1 Gustave L Levy PL
New York, NY 10029-6504
Phone (212) 659-8551

30 Prospect Ave
Hackensack, NJ 07601-1915
Phone (551) 996-5045

985 Cedar Bridge Ave
Brick, NJ 08723-4167
Phone (732) 477-5600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA08360000NJMDInternal Medicine Physician
1677921NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hackensack Meridian Health Medical Group - Specialty Care PC Internal Medicine CurrentSince Dec 1, 2008 Accepting new patients
Icahn School of Medicine at Mount Sinai Internal Medicine CurrentSince Jul 1, 2015 Accepting new patients
Fpa Hospital Based Current Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jul 1, 2015 Accepting new patients
Fpa Hospital Based CurrentSince May 1, 2014 Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Dec 1, 2008 Accepting new patients
Fpa Hospital Based CurrentSince May 1, 2014 Accepting new patients
Mount Sinai School of Medicine Past Accepting new patients
Hackensack Meridian Health Medical Group - Primary Care PC Internal Medicine Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

20 Prospect Ave
Ste 613
Hackensack, NJ 07601
Phone (201) 489-6520

160 Essex St
Ste 102
Lodi, NJ 07644
Phone (551) 996-8111

1176 5th Ave
New York, NY 10029
Phone (212) 241-6237

17 E 102nd St
New York, NY 10029
Phone (212) 241-7968

1000 10th Ave
New York, NY 10019
Phone (212) 523-2369

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: lisa.raacke@direct.hackensackmeridian.org
  • FHIR API: https://mepic.hmhn.org/fhir/api/FHIR/R4/
  • FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD

Organizations & group practices 11

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 12

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": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235520000000",
    "number": "1346215126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 PROSPECT AVE STE 613",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076011962",
            "telephone_number": "201-336-8111",
            "fax_number": "201-336-8445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 PROSPECT AVE STE 613",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076011962",
            "telephone_number": "201-336-8111",
            "fax_number": "201-336-8445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAACKE",
        "first_name": "LISA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-23",
        "last_updated": "2009-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "1677921",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA08360000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01590596",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110166628",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

Verify at the official NPI Registry.