Cathy Diane Lisenby, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0850001397 Issued in IL

Practice address

2 Good Samaritan Way
Mount Vernon, IL 62864-2408

Phone

(618) 899-4000

Fax

(618) 899-4790

NPI assigned

Aug 21, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: clisenby99453@direct-ehr-ssmhc.com

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.

• Physician Services Corporation of Southern Illinois Inc.

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1831101807
  Medicare reassignment
• John Hall MD Rural Health Services

  • Rural Health Clinic/Center
  • Mount Vernon, IL
  • NPI 1871706374
  NPD (past) Authorized official
• John Hall, M.D., P.C.

  • Adult Medicine Physician
  • Mount Vernon, IL
  • NPI 1558473645
  NPD (past)
• Premise Health of Illinois Medical, PC

  • Primary Care Clinic/Center
  • Deerfield, IL
  • NPI 1033494976
  NPD (past)

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608249600000",
    "number": "1346356524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 LAKE TER NE STE WC",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628649665",
            "telephone_number": "618-899-5001",
            "fax_number": "618-242-5152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 GOOD SAMARITAN WAY",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642408",
            "telephone_number": "618-899-4000",
            "fax_number": "618-899-4790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISENBY",
        "first_name": "CATHY",
        "middle_name": "DIANE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "0850001397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "clisenby99453@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "clisenby99453@direct-ehr-ssmhc.com",
            "address_1": "2 Good Samaritan Way",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628642408",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2 Good Samaritan Way",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628642408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Light Way ABA LLC
• Julia Light, FNP
• Lincolnshire Pharmacy
• Lipe Clinical Solutions LLC
• Christina Elizabeth Lipe, LCSW
• Jill Burnett Lisk, PT
• Litton Ambulance Service, Inc
• Living Hope Counseling PLLC
• Udaya K Liyanage, MD
• Taylor Lockowitz, PHARMD

• Physician Assistant in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; 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.

Verify at the official NPI Registry.