Individual provider Active NPI

Lisa Ann Mansueto, M.D.

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Tempe, AZ
National Provider Identifier
1396742797
Registry record updated May 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmic Plastic and Reconstructive Surgery PhysicianTaxonomy code 207WX0200X
License
23840 Issued in AZ
Practice address
3200 S Country Club Way
Tempe, AZ 85282-4054
Phone
(480) 839-0206
Fax
(480) 831-6735
NPI assigned
Jun 30, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 23840 AZ
Ophthalmic Plastic and Reconstructive Surgery Physician 207WX0200X 23840 AZ Primary

Addresses

Primary practice location

3200 S Country Club Way
Tempe, AZ 85282-4054

Mailing address

3200 S Country Club Way
Tempe, AZ 85282-4054
Phone (480) 839-0206

Other identifiers 2

IdentifierTypeStateIssuer
3743063OtherAZCIGNA
455354MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101004000367 AZ Practitioner - Ophthalmology 0345432803 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Baylor College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ophthalmic Surgeons and Physicians LTDGroup PAC ID 1052309374, 6 clinicians

Practice addresses (Care Compare)

3200 S Country Club Way
Tempe, AZ 85282-4054
Phone (480) 839-0206

Hospital & facility affiliations

  • Chandler Regional Medical Center Hospital, Chandler, AZ, CCN 030036

Merit-based Incentive Payment System (MIPS)

Final score
94.05 of 100Reported as group
Promoting interoperability
93
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
23840AZMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ophthalmic Surgeons & Physicians LTD Ophthalmology CurrentSince Aug 1, 1999 Accepting new patients
Matthew R Sullivan OD PastSince Aug 1, 1999 Accepting new patients
Surgery Center of Gilbert LLC PastSince Dec 1, 2016 Accepting new patients

Locations

5110 E Warner Rd
Ste 150
Phoenix, AZ 85044
Phone (480) 753-2591

25229 S Sun Lakes Blvd
Ste 202
Sun Lakes, AZ 85248
Phone (480) 839-0206

3200 S Country Club Way
Tempe, AZ 85282
Phone (480) 360-2020

Interoperability endpoints

  • Direct secure messaging: lmansueto@osp.emadirect.md

Organizations & group practices 3

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 1

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": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462752000000",
    "number": "1396742797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 S COUNTRY CLUB WAY",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852824054",
            "telephone_number": "480-839-0206",
            "fax_number": "480-831-6735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 S COUNTRY CLUB WAY",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852824054",
            "telephone_number": "480-839-0206",
            "fax_number": "480-831-6735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSUETO",
        "first_name": "LISA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-30",
        "last_updated": "2016-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "AZ",
            "license": "23840",
            "primary": false
        },
        {
            "code": "207WX0200X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "AZ",
            "license": "23840",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "3743063",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "455354",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tempe, AZ

Sources for this page

Verify at the official NPI Registry.