Individual provider Active NPI

Lisa Nicole Reinertson, PA-C

  • Surgical Physician Assistant
  • Phoenix, AZ
National Provider Identifier
1346503117
Registry record updated Apr 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
5145 Issued in AZ
Practice address
755 E McDowell Rd
Phoenix, AZ 85006-2506
Phone
(602) 521-3250
NPI assigned
Jun 18, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 5145 AZ Primary

Addresses

Primary practice location

755 E McDowell Rd
Phoenix, AZ 85006-2506

Mailing address

1639 W Weldon Ave
Phoenix, AZ 85015-5524
Phone (602) 521-3250

Other practice location 1

2601 E Roosevelt St
Phoenix, AZ 85008-4973
Phone (602) 344-5011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20120814000136 AZ Practitioner - Physician Assistant 5294981825 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Banner Physician Specialists Arizona LLCGroup PAC ID 6204002272, 371 clinicians

Practice addresses (Care Compare)

10401 W Thunderbird Blvd
Sun City, AZ 85351-3004
Phone (623) 832-4000

5555 W Thunderbird Rd
Banner Health Clinic
Glendale, AZ 85306-4622
Phone (602) 865-5555

5601 W Eugie Ave
Suite 100
Glendale, AZ 85304-1256
Phone (602) 865-4510

9165 W Thunderbird Rd
Suite 200
Peoria, AZ 85381-4847
Phone (623) 285-1120

Hospital & facility affiliations

  • Banner Thunderbird Medical Center Hospital, Glendale, AZ, CCN 030089

Merit-based Incentive Payment System (MIPS)

Final score
84.12 of 100Reported as group
Quality
76.35
Promoting interoperability
99
Improvement activities
40
Cost
71.55

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5145AZMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Banner - University Physician Specialists LLC CurrentSince Feb 1, 2021 Accepting new patients
Banner Physician Specialists Arizona LLC CurrentSince May 29, 2022 Accepting new patients
District Medical Group, Inc CurrentSince Jun 25, 2012 Accepting new patients
District Medical Group, Inc CurrentSince Jun 25, 2012 Accepting new patients
Banner Physician Specialists Arizona LLC Current Accepting new patients
Banner Physician Specialists Arizona LLC CurrentSince May 29, 2022 Accepting new patients
District Medical Group, Inc Past Accepting new patients

Locations

5601 W Eugie Ave
Ste 100
Glendale, AZ 85304
Phone (602) 865-4510

7701 W Aspera Blvd
Ste 102
Glendale, AZ 85308
Phone (623) 248-2100

9165 W Thunderbird Rd
Ste 200
Peoria, AZ 85381
Phone (623) 285-1120

2929 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 470-5043

4200 E Camelback Rd
Ste 104
Phoenix, AZ 85018
Phone (602) 229-2110

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

2525 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 344-1015

755 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 271-5111

1300 N 12th St
Ste 508
Phoenix, AZ 85006
Phone (602) 839-3927

2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298

10401 W Thunderbird Blvd
Sun City, AZ 85351
Phone (623) 815-7690

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 1

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": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650067200000",
    "number": "1346503117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1639 W WELDON AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850155524",
            "telephone_number": "602-521-3250",
            "fax_number": "602-521-3251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 E MCDOWELL RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062506",
            "telephone_number": "602-521-3250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2601 E Roosevelt St",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850084973",
            "country_code": "US",
            "telephone_number": "602-344-5011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REINERTSON",
        "first_name": "LISA",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-18",
        "last_updated": "2022-04-16",
        "certification_date": "2022-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "5145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.