Active NPI
Lisa Ann Mansueto, M.D.
- Ophthalmic Plastic and Reconstructive Surgery Physician
- Tempe, AZ
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmic Plastic and Reconstructive Surgery Physician
- License
- 23840
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3743063 | Other | AZ | CIGNA |
| 455354 | Medicaid | AZ |
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
Enrollment records 1
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
Practice addresses (Care Compare)
3200 S Country Club Way
Tempe, AZ 85282-4054
Phone (480) 839-0206
Hospital & facility affiliations
- Chandler Regional Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.05 of 100
- Promoting interoperability
- 93
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23840 | AZ | MD | Ophthalmology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ophthalmic Surgeons & Physicians LTD | Ophthalmology | Current | Accepting new patients |
| Matthew R Sullivan OD | Past | Accepting new patients | |
| Surgery Center of Gilbert LLC | Past | 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
- 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.
-
- Ophthalmology Physician
- Tempe, AZ
- NPI 1689648925
-
- Optometrist
- Prescott, AZ
- NPI 1285813360
-
- Ambulatory Surgical Clinic/Center
- Mesa, AZ
- NPI 1245239656
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Chandler, AZ
- NPI 1700910189
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.