Active NPI
Larry L Lisman
- Anesthesiology Physician
- Indianapolis, IN
National Provider Identifier
1376536037
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 01030377
- Practice address
- 7430 N Shadeland Ave
Suite 100
Indianapolis, IN 46250-2070 - Phone
- (317) 596-9804
- NPI assigned
- Aug 29, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 01030377 | IN | Primary |
Addresses
Primary practice location
7430 N Shadeland Ave
Suite 100
Indianapolis, IN 46250-2070
Mailing address
2901 Ohio Blvd
Suite 127
Terre Haute, IN 47803-2239
Phone (812) 234-8261
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100251430 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01030377 | IN | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Surgery Center Plus, Inc | Past | Accepting new patients |
Interoperability endpoints
- llisman311982@ecommunitydirect.com
Organizations & group practices 1
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.
-
- Surgery Physician
- Indianapolis, IN
- NPI 1396992921
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1273449600000",
"number": "1376536037",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2901 OHIO BLVD",
"address_2": "SUITE 127",
"city": "TERRE HAUTE",
"state": "IN",
"postal_code": "478032239",
"telephone_number": "812-234-8261",
"fax_number": "812-234-8262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7430 N SHADELAND AVE",
"address_2": "SUITE 100",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462502070",
"telephone_number": "317-596-9804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LISMAN",
"first_name": "LARRY",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-29",
"last_updated": "2010-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "IN",
"license": "01030377",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100251430",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.