Lisa Ann Guidry Pruett, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

N3700 Issued in TX

Practice address

8201 Preston Rd Ste 440
Dallas, TX 75225-6209

Phone

(214) 675-3227

Fax

(972) 435-4481

NPI assigned

Jul 14, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Lisa Ann Guidry Former name

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Dermatology

Education

Louisiana State University School of Medicine in New Orleans, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Revival Dermatology PLLCGroup PAC ID 7113321167, 3 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

99.7 of 100Reported as group

Quality

100

Promoting interoperability

99

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00246

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.

• Revival Dermatology PLLC

  • Dermatology Physician
  • Dallas, TX
  • NPI 1679149702
  Medicare reassignment Care Compare group NPD
• Oliver Street 5.01(a) Inc.

  • Dermatology Physician
  • Dallas, TX
  • NPI 1457695413
  Medicare reassignment NPD

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1356367106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8201 PRESTON RD STE 440",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752256209",
            "telephone_number": "214-675-3227",
            "fax_number": "972-435-4481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8201 PRESTON RD STE 440",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752256209",
            "telephone_number": "214-675-3227",
            "fax_number": "972-435-4481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUIDRY PRUETT",
        "first_name": "LISA",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "LA",
            "license": "MD026450",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "LA",
            "license": "026450",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "N3700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1065331",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04158761",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06533",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "GUIDRY",
            "middle_name": "ANN",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Guiding Minds Ministries LLC
• Guiding Tomorrow Counseling & Coaching
• Yvonne Guido Razo
• Elizabth Sage Guido, MS, OTR/L
• Sarah Elizabeth Guido
• Bradley Scott Guidry
• Christopher A Guidry, M.D.
• Devrek T Guidry Sr.
• Frantz Guignard, MD
• Sarah Guigneaux, M.S., CCC-SLP

• Dermatology Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.