NPIMap

Individual provider Active NPI

Eric Lisic, DO

  • Family Medicine Physician
  • Cookeville, TN
National Provider Identifier
1356632152
Registry record updated May 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2669 Issued in TN
Practice address
128 N Whitney Ave
Cookeville, TN 38501-2493
Phone
(931) 783-5848
Fax
(931) 528-1266
NPI assigned
Apr 27, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2669 TN Primary

Addresses

Primary practice location

128 N Whitney Ave
Cookeville, TN 38501-2493

Mailing address

140 W 7TH St
Cookeville, TN 38501-1726
Phone (931) 783-5582

Other identifiers 3

IdentifierTypeStateIssuer
6018834OtherTNBCBS
7100423360MedicaidKY
Q007183MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140916001378 TN Practitioner - Family Practice 7113163650 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Medical Group, PLLCGroup PAC ID 2860396330, 636 clinicians

Practice addresses (Care Compare)

1225 E Weisgarber Rd
Suite 200
Knoxville, TN 37849-4016
Phone (865) 938-3627

1275 Dick Lonas Rd
Knoxville, TN 37909-1326

201 E Emory Rd
Powell, TN 37849-4016
Phone (865) 938-3627

Hospital & facility affiliations

  • Adoration Home Health Nashville South Home health agency, Cookeville, TN, CCN 447425
  • NHC Homecare Murfreesboro Home health agency, Murfreesboro, TN, CCN 447114
  • Amedisys Home Health Home health agency, Livingston, TN, CCN 447260
  • Suncrest Home Health Home health agency, Smithville, TN, CCN 447176
  • Quality Home Health Home health agency, Jamestown, TN, CCN 447406
  • Cookeville Regional Medical Center Hospital, Cookeville, TN, CCN 440059
  • Cumberland Medical Center Hospital, Crossville, TN, CCN 440009

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions28

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2669TNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, PLLC Family Medicine CurrentSince May 1, 2023 Accepting new patients
Summit Medical Group, PLLC CurrentSince May 1, 2023 Accepting new patients
Cookeville Regional Medical Group, Inc CurrentSince Aug 18, 2014 Accepting new patients
Summit Medical Group,PLLC Past Accepting new patients
Summit Medical Group, PLLC Family Medicine Past Accepting new patients

Locations

128 N Whitney Ave
Cookeville, TN 38501
Phone (931) 528-7662

100 W 4th St
Ste 350
Cookeville, TN 38501
Phone (931) 646-2901

127 N Oak Ave
#D
Cookeville, TN 38501

228 W 4th St
Ste 301
Cookeville, TN 38501
Phone (931) 526-4349

140 W 7th St
Cookeville, TN 38501
Phone (931) 783-5582

1275 Dick Lonas Rd
Unit 101
Knoxville, TN 37909

1225 E Weisgarber Rd
Ste 200
Knoxville, TN 37909
Phone (865) 938-3627

Interoperability endpoints

  • Direct secure messaging: eric.lisic.1@20785.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/10383/brand/1/csg/1/fhir/r4

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.

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": "1303862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653523200000",
    "number": "1356632152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 W 7TH ST",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385011726",
            "telephone_number": "931-783-5582",
            "fax_number": "931-526-6760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 N WHITNEY AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012493",
            "telephone_number": "931-783-5848",
            "fax_number": "931-528-1266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISIC",
        "first_name": "ERIC",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-27",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "2669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "6018834",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100423360",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q007183",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

Verify at the official NPI Registry.