NPIMap

Individual provider Active NPI

Anna Lizza Lopez Siasoco, M.D.

  • Family Medicine Physician
  • Port Washington, NY
National Provider Identifier
1386614428
Registry record updated Sep 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
236459 Issued in NY
Practice address
415 Port Washington Blvd
Port Washington, NY 11050-4201
Phone
(516) 883-0218
Fax
(516) 767-0894
NPI assigned
Jan 23, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 12, 2014

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 236459 NY Primary

Addresses

Primary practice location

415 Port Washington Blvd
Port Washington, NY 11050-4201

Mailing address

415 Port Washington Blvd
Port Washington, NY 11050-4201
Phone (516) 883-0218

Other identifiers 6

IdentifierTypeStateIssuer
5C5341OtherNYHEALTH NET OF NORTHEAST
9412517OtherNYPHCS
3363P1OtherNYEMPIRE BLUECROSS BLUESHIE
5880458OtherNYCIGNA
5995775OtherNYGHI
SA6459OtherNYATLANTIS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20050930000094 NY Practitioner - HospitalistPractitioner - Family Practice 9739114562 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Family Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
CHS Physician Partners PCGroup PAC ID 7618955667, 739 clinicians

Practice addresses (Care Compare)

50 Route 25a
Smithtown, NY 11787-1348
Phone (631) 862-3000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Suffolk Medical, P.C. CurrentSince Jan 1, 2016 Accepting new patients
CHS Physician Partners, P.C CurrentSince Jul 1, 2022 Accepting new patients
CHS Physician Partners, PC Current Accepting new patients
Southwest Suffolk Medical PC Family Medicine CurrentSince Jan 1, 2016 Accepting new patients
St Francis Hospital United States Catholic Conference Past Accepting new patients

Locations

245 Old Country Rd
Melville, NY 11747
Phone (631) 465-6141

2800 Marcus Ave
New Hyde Park, NY 11042
Phone (516) 622-6131

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

100 Port Washington Blvd
Roslyn, NY 11576
Phone (516) 562-6385

100 Port Washington Blvd
Ste G3
Roslyn, NY 11576
Phone (516) 627-4800

48 Route 25A
Smithtown, NY 11787
Phone (631) 862-3540

50 Route 25A
Smithtown, NY 11787
Phone (631) 465-6225

994 W Jericho Tpke
Ste 103
Smithtown, NY 11787
Phone (631) 864-6647

373 Route 111
Ste 14
Smithtown, NY 11787
Phone (631) 265-0050

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: asiasoco23298@direct-chsli.net

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410480000000",
    "number": "1386614428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 PORT WASHINGTON BLVD",
            "city": "PORT WASHINGTON",
            "state": "NY",
            "postal_code": "110504201",
            "telephone_number": "516-883-0218",
            "fax_number": "516-767-0894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 PORT WASHINGTON BLVD",
            "city": "PORT WASHINGTON",
            "state": "NY",
            "postal_code": "110504201",
            "telephone_number": "516-883-0218",
            "fax_number": "516-767-0894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIASOCO",
        "first_name": "ANNA LIZZA",
        "middle_name": "LOPEZ",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-23",
        "last_updated": "2014-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "236459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET OF NORTHEAST",
            "identifier": "5C5341",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "9412517",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BLUECROSS BLUESHIE",
            "identifier": "3363P1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5880458",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "5995775",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ATLANTIS",
            "identifier": "SA6459",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Washington, NY

Sources for this page

Verify at the official NPI Registry.