Individual provider Active NPI

Lisa M.L. Parker, MD

  • Pediatrics Physician
  • Smithfield, NC
National Provider Identifier
1346298973
Registry record updated Feb 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
9901279 Issued in NC
Practice address
101 Kellie Dr
Smithfield, NC 27577-9443
Phone
(919) 938-3749
Fax
(919) 938-3749
NPI assigned
May 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 9901279 NC Primary

Addresses

Primary practice location

101 Kellie Dr
Smithfield, NC 27577-9443

Mailing address

104 Rhodes Ave
Windsor, NC 27983-9656
Phone (252) 794-3042

Other identifiers 1

IdentifierTypeStateIssuer
891223VMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240108000059 NC Practitioner - Pediatric Medicine 7517318215 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9901279NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bertie County Rural Health Association CurrentSince Nov 2, 2023 Accepting new patients
Bertie County Rural Health Association CurrentSince Nov 2, 2023 Accepting new patients
Bertie County Rural Health Association Past Accepting new patients
Bertie County Rural Health Association PastSince Feb 2, 2020 Accepting new patients
Kids Care Pediatrics PA Pediatrics Past Accepting new patients

Locations

104 Rhodes Ave
Windsor, NC 27983
Phone (252) 794-1835

Interoperability endpoints

  • Direct secure messaging: lisa.parker@direct.bcrha.nchie.net
  • Direct secure messaging: lparker746074@direct.ochin.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740614400000",
    "number": "1346298973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 RHODES AVE",
            "city": "WINDSOR",
            "state": "NC",
            "postal_code": "279839656",
            "telephone_number": "252-794-3042",
            "fax_number": "252-794-2911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 KELLIE DR",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "275779443",
            "telephone_number": "919-938-3749",
            "fax_number": "919-938-3749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKER",
        "first_name": "LISA",
        "middle_name": "M.L.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-05",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "9901279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891223V",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithfield, NC

Sources for this page

Verify at the official NPI Registry.