Lisa A Bodine, PA-C
Individual provider Active NPI Physician Assistant · Washington, DC
NPI 1386084572 · NPPES record last updated Mar 17, 2025
Key facts
- NPI
- 1386084572
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA031171 (DC)
- Practice address
- 1350 Connecticut Ave NW Ste 1250
Washington, DC 20036-1728 - Phone
- (202) 627-1901
- Fax
- (415) 252-7176
- NPI assigned
- Jul 2, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131029000292 | DC | Practitioner - Physician Assistant | 6002041084 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA031171 | DC | MD | Physician Assistant |
| 11108 | GA | MD | Physician Assistant |
| 0010-12147 | NC | MD | Physician Assistant |
| 0110004298 | VA | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110004298 | VA | |
| Physician Assistant | 363A00000X | 11108 | GA | |
| Physician Assistant | 363A00000X | 0010-12147 | NC | |
| Physician Assistant | 363A00000X | PA031171 | DC | Yes |
Addresses
Primary practice location
1350 Connecticut Ave NW Ste 1250
Washington, DC 20036-1728
Mailing address
1 Embarcadero Ctr Ste 1900
San Francisco, CA 94111-3723
Phone (415) 658-6791
Other providers in Washington, DC
- Sheriff Bockarie
- Siah Hawa Bockarie
- Loren Bockweg
- Kim Monique Boddie
- David Victor Bode
- Nia I Bodrick
- Olayinka Juliana Bodunrin
- Body Connect Health and Wellness, LLC
- Body Image Therapy Center Intensive
- Bodywavez Fitness
All providers in Washington, DC · Physician Assistant in District of Columbia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.