Individual provider Active NPI

Lisamarie Pietragallo, NP-C

  • Family Nurse Practitioner
  • Warren, OH
National Provider Identifier
1376946319
Registry record updated Jul 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
COA.-16648-NP Issued in OH
Practice address
9375 E Market St
Suite 1
Warren, OH 44484-5552
Phone
(330) 609-5089
NPI assigned
Oct 6, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X COA.-16648-NP OH Primary
Primary Care Nurse Practitioner 363LP2300X 16648-NP OH

Addresses

Primary practice location

9375 E Market St
Suite 1
Warren, OH 44484-5552

Mailing address

9375 E Market St
Suite 1
Warren, OH 44484-5552
Phone (330) 609-5089

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, KY, PA3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20150121002289 OH Practitioner - Nurse Practitioner 0345564308 Reassigns benefits to 1 organization
I20170207000340 KY Practitioner - Nurse Practitioner 0345564308 Reassigns benefits to 1 organization
I20170426000088 PA Practitioner - Nurse Practitioner 0345564308 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
COA.-16648-NPOHMDFamily Nurse Practitioner
16648-NPOHMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Meditelecare of Pennsylvania LLC CurrentSince Dec 7, 2020 Accepting new patients
Medoptions of Ohio LLC Family CurrentSince Oct 1, 2016 Accepting new patients
Medoptions of Kentucky LLC CurrentSince Jan 25, 2017 Accepting new patients
Triad Health Services, LLC Family Past Accepting new patients

Locations

1595 S US Highway 231
Beaver Dam, KY 42320
Phone (270) 274-4477

50 W Broad St
Ste 1330
Columbus, OH 43215
Phone (630) 320-6871

1160 Dublin Rd
Ste 400
Columbus, OH 43215
Phone (502) 439-2617

600 N 2nd St
Ste 401
Harrisburg, PA 17101
Phone (844) 341-2339

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1412553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467763200000",
    "number": "1376946319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9375 E MARKET ST",
            "address_2": "SUITE 1",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444845552",
            "telephone_number": "330-609-5089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9375 E MARKET ST",
            "address_2": "SUITE 1",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444845552",
            "telephone_number": "330-609-5089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIETRAGALLO",
        "first_name": "LISAMARIE",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-06",
        "last_updated": "2016-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA.-16648-NP",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OH",
            "license": "16648-NP",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, OH

Sources for this page

Verify at the official NPI Registry.